Variation in catheter management and predictors of trial without catheter success in men with AUR: results from the AUR-SNAPSHOT study

This study aimed to assess practice variation in the timing and management of trial without catheter (TWOC) following acute urinary retention (AUR) in Dutch hospitals. Secondary objectives were to identify clinical predictors of TWOC success and evaluate catheter-related complications. We conducted a retrospective cross-sectional observational study across multiple Dutch hospitals. Male patients aged ≥18 years with a single episode of spontaneous AUR were identified using electronic health record queries. Data collected included catheter duration, alpha-blocker use, TWOC outcomes, predictors of success, and complications. TWOC success was defined as spontaneous voiding with acceptable post-void residual, as judged by the local clinician. Predictors were determined with multivariable binomial logistic regression. A total of 299 men (mean age 73.1 ± 9.4 years) were included from January 2022 to June 2022. Median drained volume was 1000mL (IQR 750-1500mL), and median catheter duration was 15 days (IQR 6-23 days). TWOC success varied across hospitals (14-55%). Catheter duration and alpha-blocker were not significant predictors. Older age (OR 0.93, p =0.001) and larger drained volume (OR 0.99, p <0.001) were associated with lower success, while alcohol consumption increased success odds (OR 3.54, p =0.016). The study is limited by the retrospective design, lack of standard definition for TWOC success, and observational nature. Substantial variation exists in catheter duration and TWOC management across Dutch hospitals. Age, drained volume, and alcohol use were significant predictors of TWOC outcome. However, the association with alcohol should be interpreted as an indication that non-BOO causes of AUR may resolve spontaneously. Findings highlight the need for standardised protocols and support future multicenter randomized trials to optimize care, reduce complications, and improve patient quality of life.