Predictors of Acute Urinary Retention in Men with Benign Prostatic Hyperplasia: A Prospective Observational Study

Abstract Background: Acute urinary retention (AUR) is a painful complication of benign prostatic hyperplasia (BPH) that can be treated with emergency catheterization. Determining dependable clinical predictors of AUR would provide the ability to follow the changes and preemptively treat high-risk patients. Objective: The objective of the study is to identify independent clinical, biochemical, and ultrasonographic predictors of AUR in men with BPH. Materials and Methods: This was a prospective observational study that involved the enrolment of 120 male patients who were known to have BPH in a tertiary urological center. The participants were divided into an AUR ( n = 60) and non-AUR (only lower urinary tract symptoms [LUTS]) group ( n = 60). Student’s t -test and Chi-square analyses were used to compare and assess the severity of symptoms (International Prostate Symptom Score [IPSS]) and prostate volume (PV), as well as thickness of the Bladder wall thickness (BWT) and intravesical prostatic protrusion (IVPP), and serum prostate-specific antigen (PSA). Independent predictors were determined using multivariable logistic regression. Results: On multivariable analysis, five parameters were independently associated with AUR: IPSS score (adjusted odds ratio [OR] 1.18 per point; 95% confidence interval [CI] 1.10–1.27), PV (OR 1.03/g; 95% CI 1.01–1.05), BWT ≥5 mm (OR 4.29; 95% CI 2.15–8.58), IVPP grade II–III (OR 6.84; 95% CI 3.22–14.53), and serum PSA ≥4 ng/mL (OR 2.78; 95% CI 1.38–5.59; all P < 0.05). Other factors, including age, comorbidity burden, grade of digital rectal examination, and urinary tract infection, were insignificant. The hybrid model gave an area under the receiver-operating characteristic curve of 0.89 (95% CI 0.83–0.95). Conclusion: IVPP is the strongest independent predictor of AUR in men with BPH, followed by BWT, serum PSA, PV, and IPSS. Routine integration of these parameters into clinical assessment enables stratification of high-risk patients who may benefit from early pharmacological or surgical intervention.