When Is a Trial Without Catheter Done After BPH-Related Retention?

Note: This information is mainly for adult men whose acute urinary retention is thought to be caused by an enlarged prostate (Benign Prostatic Hyperplasia, or BPH). If your retention is due to a neurologic issue, recent surgery, or another cause, your care plan may look different.

After you go to the emergency room or clinic for acute urinary retention, a catheter is placed to drain the backup of urine. This relieves painful pressure on your bladder and, in some cases, protects your kidneys ^[1]. This catheter usually stays in place for a few days before your care team removes it to see if you can urinate on your own again. This process is called a Trial Without Catheter (TWOC).

Preparing for the Trial

While the catheter is in place, your doctor may check your urine and blood for signs of infection or kidney problems ^[2][3]. They will also review your current medications, as some drugs can make it harder to urinate ^[2].

To prepare your body for the trial, your doctor will likely prescribe an alpha-blocker (such as alfuzosin, tamsulosin, or silodosin). This medication relaxes the muscles in and around the prostate ^[4][5]. Taking an alpha-blocker before removing the catheter increases your chances of a successful trial ^[6][7]. However, it does not guarantee success and can cause side effects like dizziness or drops in blood pressure, especially in older adults ^[8]. Take it exactly as prescribed and tell your doctor if you feel dizzy or faint.

Catheter Care at Home: While waiting for your trial, keep the drainage bag below the level of your bladder, and do not try to remove the catheter yourself. Seek immediate medical attention if you develop a fever, chills, worsening lower abdominal pain, severe bleeding, or if the catheter stops draining entirely.

When will the catheter be removed?

The timing of your trial is individualized based on your kidney function, bladder health, and local clinic protocols. A very common approach is to attempt the trial 2 to 3 days after the catheter was placed ^[4][9].

Research suggests that leaving a catheter in for a longer period (such as 7 days) significantly increases the risk of complications, including urinary tract infections, leakage, bleeding, or catheter blockage ^[10]. For most men, a shorter period reduces these risks without compromising the chances of a successful trial ^[4].

What happens on the day of the trial?

On the day of your trial, a healthcare professional will remove the catheter. You will be asked to drink fluids and wait until you feel the urge to urinate. After you try to pee, the care team will measure how much urine came out. They will then use a painless ultrasound machine (a bladder scan) to check your post-void residual—the amount of urine left behind in your bladder ^[2]. If you cannot urinate at all, or if you only dribble, tell the clinic staff immediately so they can safely empty your bladder.

What are the chances of success?

With the help of an alpha-blocker, roughly 50% to 60% of men are able to urinate successfully during their first trial, though individual estimates vary widely ^[7]. Your personal chances depend on several factors:

• Prostate size: Men with larger prostates generally have a harder time urinating after the catheter is removed ^[11][12].
• Amount of retained urine: If your bladder was stretched by a very large amount of trapped urine, the bladder muscle may need more time to recover its squeezing power ^[11].
• Age: Older age is frequently associated with a lower chance of success ^[11][12].
• Prior symptoms: Men who had severe urinary symptoms before the retention episode may face a higher risk of the trial failing ^[13].

These factors are just general associations seen in studies, not strict rules. There is no single age or retained volume that guarantees you will pass or fail.

What happens if the trial fails?

If you cannot urinate, or if your bladder retains too much urine after you go, the trial has “failed.” This simply means your bladder still needs help draining. It can be frustrating, but it is a common medical step, not a personal failure. Your doctor will discuss several options to keep your bladder safely decompressed:

• Recatheterization: Another temporary catheter may be placed to drain the bladder ^[14].
• Clean Intermittent Self-Catheterization (CISC): Instead of a continuous tube, a nurse can teach you how to insert a small, clean tube yourself just when you need to empty your bladder ^[15]. This can reduce continuous catheter discomfort, but it requires good hand dexterity, vision, and training, so it is not feasible for everyone ^[16][4].
• Repeat Trial: In some cases, your doctor may suggest waiting a bit longer on medication and trying a second trial ^[14].
• Definitive BPH Treatment: A failed trial often prompts a discussion about procedures to physically open the blocked urine channel ^[5]. Options include TURP (surgery to remove obstructing prostate tissue) or laser enucleation ^[17]. Surgery is not immediately mandatory, but it is a highly effective option for men whose bladders remain blocked.

What if the trial is successful?

If you successfully urinate and empty your bladder, you will be able to go home without a catheter. However, you will still need regular urology follow-up. You may be instructed to continue taking your alpha-blocker to keep the prostate relaxed. Because men who have had one episode of acute retention are at a higher risk of having another one in the future ^[18], your doctor will monitor you and may eventually discuss long-term treatments for your enlarged prostate.