背景：
急性尿液滯留是攝護腺肥大患者嚴重的併發症之一，其緊急處置方式為置入導尿管來引流尿液。嘗試導尿管移除(weaning catheter)是目前準則建議該類型患者後續的處置方式。但是，部分患者在移除導尿管之後，仍然無法順利排尿，必須再將導尿管置入，而反覆性的置入導尿管會增加泌尿道的感染與相關併發症的機率。因此，我們在思考是否可以藉由預測因子的幫助，提早了解病患在移除導尿管之後的可能結果。針對容易失敗的族群，積極的追蹤與治療，及早篩選出適合手術的病患，以提升臨床照護成效。
目的：探討在攝護腺肥大合併急性尿液滯留的病患當中，其可能影響成功移除導尿管之預測因子有哪些？

方法：
本研究設計為病例回顧性，病歷的資料來自於南部某醫學中心，回顧時間自2011年09月06日至2017年12月31日。收納檢視因急性尿液滯留而前來就診病患的臨床資料，依移除尿管成功與否，分成移除成功與移除失敗兩組做比較。統計方式使用羅吉斯回歸模型分析(Logistic regression model)以及接收者操作特徵曲線（receiver operating characteristic curve，簡稱ROC曲線）來探討可能影響成功移除導尿管的預測因子。

結果：
總共收納504位病患，移除成功組152位，移除失敗組352位。尿液滯留量、攝護腺體積、攝護腺特異性抗原及膀胱內攝護腺突入大小都是以移除失敗組為較多。次族群分析時可以看到60至69歲年紀族群、攝護腺體積大於等於60毫升、尿液滯留量大於等於600毫升、攝護腺特異性抗原大於4、較高等級的膀胱攝護腺突入大小以及沒有使用甲型阻斷劑等等都有比較高的移除失敗風險。在邏輯式回歸中也看到單變數分析中：尿液滯留量，攝護腺大小，攝護腺特異性抗原指數大於等於12，以及攝護腺突入膀胱內部的大小都與移除尿管成功與否有關。多變數分析時則發現當尿液滯留量大於等於600毫升，與攝護腺體積大於等於60毫升時有最顯著的相關連性。

結論：
當尿液滯留量大於等於600毫升時，與攝護腺體積大於等於60毫升時，其移除尿管成功的機率顯著的減少。建議可以立即考慮以手術方式來做處理。

Acute urinary retention (AUR) is one of the most severe complications to the patients with benign prostate hyperplasia (BPH). The emergent management method is to insert the Foley catheter for urine drainage. Many patients insist trying weaning catheters, despite repeatedly failed weaning. Repeated Foley catheterization would result in many complications, such as urinary tract infections, catheter-associated hematuria, urethral discomfort…….etc. In order to provide the better quality and evidenced-based care, we try to identify the factors associated with successful weaning Foley catheters. For those patients with little chance of successful weaning, we could then recommend early surgery intervention. We perform a retrospective study. The data comes from the electronic medical chart of National Cheng Kung University Hospital. We include BPH patients with acute urinary retentions, whom present in the outcome patient department and emergent room department. The study period is from September 06, 2011 to December 31, 2017. Logistic regression analysis and receiver operating characteristic curve are used to set up the predicting model. Totally 504 patients were included. 152 patients were in the successful group, and 352 patients in the failed group. We found that if the residual urine amount ≥ 600ml or prostate volume ≥ 60ml of the BPH patients with AUR, the probability of successful weaning Foley catheter is decreased. We suggest these patient should consider surgical treatment first.

Keywords: acute urinary retention(AUR), benign prostate hyperplasia(BPH), weaning catheter, residual urine amount(RUA), prostate volume(PV).

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