Role in acute urinary retention

The relationship between prostatic infarction and acute urinary retention was studied. Serial sections of two groups of 100 prostates each were studied for evidence of infarction. One group consisted of patients with acute urinary retention while the other group consisted of patients with benign prostatic hypertrophy. Eighty-five per cent of the retention group had prostatic infarcts while only 3 per cent of the patients with benign prostatic hypertrophy had infarcts. Despite the close association of acute urinary retention with infarction of the prostate, the exact mechanism in the production of acute retention is as yet undetermined.     

Management of acute urinary retention

Acute urinary retention (AUR) is a common urological emergency, characterized by a sudden and painful inability to pass urine. There is high variability within and among countries in its management, which can be explained not only by differences in access to care but also by a lack of harmonization and consensus on the best way to proceed. Immediate treatment consists of bladder decompression, usually by a urethral catheter, although a suprapubic catheter offers several advantages not often exploited by urologists. Until recently, secondary management consisted almost exclusively of prostatic surgery within a few days (emergency surgery) or a few weeks (elective surgery) after a first AUR episode. The greater morbidity and mortality associated with emergency surgery, and the potential morbidity associated with prolonged catheterization, has led to the increasing use of a trial without catheter; this involves catheter removal after 1-3 days, allowing the patient to void in 23-40% of cases, and surgery, if needed, at a later stage. Alpha1-adrenergic blockers given before catheter removal improve the chances of success. A high prostate-specific antigen level and postvoid residual urine volume, and response to alfuzosin treatment after a first AUR episode managed conservatively, may help to identify patients at risk of an unfavourable outcome.     

Urethral steinstrasse causing acute urinary retention

Multiple urethral calculi-forming steinstrasse in the urethra leading to acute urinary retention is a rare event in pediatric urolithiasis. We report a child with urethral steinstrasse that cleared spontaneously with attempted urethral catheterization.     

Clinical study of acute urinary retention

PURPOSE: Clinical study of acute urinary retention seen by this department. MATERIALS AND METHODS: Subjects were 206 cases seen during office hours and during after-hours emergency care by the department of Urology at the Kinki University Hospital for acute urinary retention for the 12-year-period from April 1993 to April 2005. RESULTS: By gender, the 206 cases of acute urinary retention included 175 men (85%) and 31 women (15%). The ratio of men to women was 5.6:1, with a markedly larger number of male cases. Ages of the 206 cases overall were distributed from 6 to 93 years old and the mean age was 66 years old. In male cases, the mean age was 69.6 years old while in female cases it was 46.3 years old. With regard to the cause, bladder outlet obstruction (BOO) accounted for 123 (70.3%) of the 175 male cases; benign prostatic hyperplasia (BPH) was noted in 92 cases and accounted for 52.6%of the total. Detrusor Weakness (DW) was noted in 35 cases (20%). DW was most prevalent in women, being noted in 20 cases (64.5%). With regard to treatment, in male cases surgery was performed for BOO in 69 (56%) of 123 cases; surgery was performed for BPH in 56 (60.8%) of 92 cases, drug therapy was used in 19 cases, and 3 cases were observed. In female cases, 10 cases were able to urinate on their own through treatment of the causative disorder. With regard to outcome, ultimately a total of 139 cases (67.5%), 125 men and 14 women, were able to urinate on their own. CONCLUSIONS: 1. 85% of acute urinary retention cases were men. Of these, 70% were caused by some form of BOO. DW due to a cause other than obstruction accounted for about 70% of the remaining 30%. 2. Overall, 70% of cases were able to urinate on their own after treatment while 30% required catheterization. 3. After the cause of BOO was eliminated, cases were likely to be able to urinate on their own; CIC (clean intermittent catheterization) was frequently used in treatment of causes other than BOO. 4.15% of acute urinary retention cases were women.     

Long-term renal dysfunction in patients with acute urinary retention

OBJECTIVE: Acute urinary retention (AUR) causes bilateral renal obstruction, which has been found to affect kidney function. This study evaluated both glomerular and tubular renal function in the long term after the resolution of AUR. MATERIAL AND METHODS: Renal function in 15 patients affected by AUR and found still to evince renal dysfunction 6 months afterwards was re-evaluated approximately 18 months after the episode. The bladder outlet obstruction was treated and all patients voided normally at 6 month control. RESULTS: The percentage of patients suffering from lowered creatinine clearance and elevated alpha1-microglobulin excretion increased during follow-up from AUR up to 6 and 18 months (46% to 57% to 79% and 42% to 71% to 100%, respectively). In addition, daily protein excretion was abnormally high in 69% of patients at the 18 month follow-up. In most cases the abnormalities found in renal function were mild. CONCLUSION: Patients evincing renal dysfunction 6 months after AUR showed permanent impairment in tubular function, whereas glomerular permeability had partially recovered. Although this may be explained in part by chronic obstruction prior to AUR and although the impairment was mild in most cases, these findings stress the importance of urgent treatment of AUR to avoid the development of renal failure.     

Atresia hymenalis with acute urinary retention: a case report

We report a case of atresia hymenalis in a 14-year-old girl presenting with a clinical symptom of acute urinary retention. On physical examination she was found to have a lower abdominal mass and an imperforate bulging hymen. She underwent hymenal incision, and subsequently the symptom disappeared. It is very uncommon for atresia hymenalis to manifest itself with acute urinary retention as the first clinical sign, but we should consider this disease if a pubertal girl seeks medical opinion for acute urinary retention.     

Intravenous urography after acute urinary retention.

The results of a 12-month prospective study of 113 patients show that intravenous urography has no place in the management of men with acute urinary retention without haematuria.     

Urachal cyst presenting as acute urinary retention

About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms.     

Necrotic pancreatic graft causing acute urinary retention

Urologic complications are frequently encountered after pancreas transplantation with a graft duodenocystostomy. Urinary infections, hematuria, and irritative voiding symptoms are some of the most frequent complications with a bladder-drained pancreas allograft. While voiding dysfunction is common in these patients due to underlying neuropathy, to our knowledge, we report the first case of obstructive uropathy in a female due to retained necrotic graft material.     

Holmium laser prostatic resection for patients presenting with acute urinary retention

OBJECTIVE

To compare the outcomes of patients presenting with and without acute urinary retention (AUR) who were treated with 100‐W holmium laser resection of the prostate (HoLRP), as laser therapies, including HoLRP, have been used for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH), but the effectiveness of HoLRP for patients with AUR has not been fully elucidated.

PATIENTS AND METHODS

The medical records of 87 patients who had HoLRP were reviewed, and prospective questionnaires aimed at determining patients’ American Urologic Association Symptom Index (AUA‐SI) and Quality‐of‐Life (QoL) scores and medication usage were also obtained. Statistical analyses were used to compare the clinical characteristics and outcomes between patients with and with no AUR for up to 2 years after HoLRP.

RESULTS

All patients had the catheter removed successfully by 1 month after surgery; those presenting with AUR tended to have a greater improvement in clinical outcomes than those with no AUR, including a mean AUA‐SI score decrease by ≈13 and ≈8 points, and a QoL score decrease by ≈2 and ≈1.4 points, respectively. These decreases were maintained throughout the study period. Patients with AUR had significantly greater decreases in their postvoid residual urine volume than those with no AUR. Serum prostate‐specific antigen levels also had a modest but sustained decrease (14%) in both groups. There were no significant decreases in the reported use of BPH‐related medications after surgery in either group.

CONCLUSIONS

HoLRP (100 W) is a safe and effective surgical therapy for patients presenting with AUR. The present results suggest that the short‐ and long‐term outcomes of these patients are similar between men presenting with and with no AUR.     

Prostate size influences the outcome after presenting with acute urinary retention

OBJECTIVE: To evaluate the long-term outcome in an open follow-up of a cohort of patients who had had a successful trial without catheter (TWOC) after an episode of acute urinary retention (AUR), as it is now widely accepted that giving an alpha-blocker, e.g. alfuzosin, increases the success rate of TWOC. PATIENTS AND METHODS: In this prospective trial, 81 patients with a first episode of AUR related to benign prostatic obstruction received either sustained-release alfuzosin (40) 5 mg twice daily or placebo (41) for 48 h. The catheter was removed after 24 h of treatment and the patient's ability to void assessed. Those who voided successfully entered an open follow-up, the defined endpoints of which were the date of recurrent AUR, date of bladder outlet surgery, date of last follow-up or death, and factors that influenced the long-term outcome after a successful TWOC were examined. RESULTS: Of the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an alpha-blocker at the discretion of their urologist. In all, 26 had a further episode of AUR or surgery during the 6-year follow-up. The mean (median, range) time to the second episode of AUR in the 20 (59%) patients affected was 1.4 (0.6, 0-5.95) years. Nineteen (56%) men had bladder outlet surgery, 13 after a second episode of AUR. The mean time to operation after the first AUR was 1.85 (1.1, 0.04-5.4) years. The remaining eight (24%) patients remained free of further AUR and surgery. The size of the prostate assessed on a digital rectal examination by the admitting urologist was the only factor with a significant effect on the long-term outcome. A postvoid residual of > 50 mL was associated with a greater likelihood of recurrent AUR or surgery, but this was not statistically significant. CONCLUSIONS: This study provides further evidence of the importance of prostate size as a prognostic factor in determining the outcome in patients with prostatic obstruction. Whilst most men presenting with AUR will eventually have prostatic surgery, a significant minority will not. An assessment of risk factors such as prostate size may identify those who require urgent intervention after a successful TWOC. The role of continued medical therapy with alpha-blockers and/or 5alpha-reductase inhibitors after a successful TWOC merits further investigation.