Incidence of primary and recurrent acute urinary retention between 1998 and 2003 in England

PURPOSE: We report how the incidence of primary and recurrent acute urinary retention changed in England between 1998 and 2003. In addition, we present data on changes with time in the use of prostatectomy after acute urinary retention and recurrent acute urinary retention. MATERIALS AND METHODS: Data were extracted from the Hospital Episode Statistics database of the Department of Health in England. Patients were included in the study if an International Classification of Diseases, Tenth Revision code for acute urinary retention or an operative procedure code for transurethral prostate resection was present in any diagnosis or procedure fields of the Hospital Episode Statistics database. A total of 165,527 men were identified to have been hospitalized with acute urinary retention in the study period. RESULTS: The incidence of primary acute urinary retention was 3.06/1,000 men yearly. Acute urinary retention was spontaneous in 65.3% of cases. The incidence of acute urinary retention decreased from 3.17/1,000 men yearly in 1998 to 2.96/1,000 yearly in 2003. Surgical treatment following spontaneous acute urinary retention decreased 20% from 32% in 1998 to 26% in 2003. This trend coincided with a 20% increase in the rate of recurrent acute urinary retention. CONCLUSIONS: The slight decrease in the incidence of primary acute urinary retention suggests that the shift away from surgical treatment for benign prostatic hyperplasia has not resulted in an increase in acute urinary retention. The increase in recurrent acute urinary retention suggests that the observed decrease in surgery after acute urinary retention may have put more men at risk for acute urinary retention recurrence.     

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.     

Response to daily 10 mg alfuzosin predicts acute urinary retention and benign prostatic hyperplasia related surgery in men with lower urinary tract symptoms

PURPOSE: We analyzed the influence of treatment response on the risk of acute urinary retention and benign prostatic hyperplasia related surgery in 5,792 men complaining of lower urinary tract symptoms who were treated for 6 months with the selective alpha1-blocker alfuzosin at 10 mg once daily. MATERIALS AND METHODS: The influence of dynamic variables (International Prostate Symptom Score change and bother during treatment) and baseline variables (patient age, prior acute urinary retention managed conservatively, prostate specific antigen, International Prostate Symptom Score and bother severity) on the risk of acute urinary retention and benign prostatic hyperplasia related surgery was estimated using the Kaplan-Meier method and log rank test. The associated HR and 95% CI were calculated using Cox proportional hazard models. RESULTS: During alfuzosin treatment International Prostate Symptom Score improved by 3 or greater and greater than 6 points in 74.8% and 50.3% of men, respectively. In this unselected population, including 3.8% with prior unoperated acute urinary retention, the rate of acute urinary retention and benign prostatic hyperplasia related surgery events during treatment was low (0.5% and 1.1%, respectively). Men with stable or worsening International Prostate Symptom Score were at increased risk for acute urinary retention or surgery (HR 3.75, 95% CI 1.58 to 8.89, p = 0.003 and HR 4.71, 95% CI 2.69 to 8.24, p <0.001, respectively). Prior acute urinary retention was a strong predictor of acute urinary retention relapse and surgery (HR 10.35, 95% CI 4.29 to 26.08, p <0.001 and HR 3.57, 95% CI 1.59 to 7.98, p = 0.002, respectively). Bother score greater than 3 during treatment was the strongest predictor of surgery (HR 7.61, 95% CI 4.16 to 13.93, p <0.001). Prostate specific antigen had much less predictive value. CONCLUSIONS: This 6-month real life practice study shows that alfuzosin is associated with a low incidence of acute urinary retention and benign prostatic hyperplasia related surgery. It also suggests that responder status is the most important predictor of acute urinary retention and benign prostatic hyperplasia related surgery. Thus, first line treatment with alfuzosin may help select patients at risk for benign prostatic hyperplasia progression to optimize treatment.     

Acute urinary retention in a child due to pyocolpos and pyometrium

Acute urinary retention in a child is an unusual occurrence. A case of acute urinaryretention due to pyocolpos and pyometrium is presented and discussed. Emphasis is on early diagnosis and treatment by drainage to alleviate progressive obstruction of the urinary tract. Other causes of acute urinary retention in the pediatric age group are briefly outlined.     

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.     

A placebo controlled double blind study using perioperative prazosin in the prevention of urinary retention following inguinal hernia repair

Acute urinary retention is a frequent complication following inguinal hernia repair. The smooth muscle of the bladder neck and the prostate have been demonstrated to be rich in alpha-1 adrenergic receptors. It has been postulated that the aetiology of acute urinary retention postoperatively is at least partially due to adrenergic stimulation, blocking these receptors may reduce the incidence of acute urinary retention. We have used prazosin in a double blind, placebo controlled study to establish its efficacy in the prevention of acute urinary retention in patients undergoing elective inguinal hernia repair. A total of 70 male patients were enrolled; 36 patients had been allocated active drug and 34 patients had been allocated placebo. Only two patients developed acute urinary retention. Both patients had been allocated prazosin and had received a general anaesthetic for their hernia surgery. In either arm of the study, a higher number of patients developing urinary retention would have been expected but this may be explained by the greater vigilance on urinary output by nursing staff aware that the trial was being conducted. On the basis of our findings, we do not recommend the routine use of perioperative prazosin with inguinal hernia repair. Further studies in high risk groups would be necessary to assess more fully the efficacy of prazosin in this situation.     

急性尿潴留对血清前列腺特异性抗原的影响

目的 :研究良性前列腺增生 (BPH)病人发生急性尿潴留时对血清前列腺特异性抗原 (PSA)的影响。　方法 :对 34例伴有急性尿潴留的BPH病人 ,于膀胱造瘘前及引流尿液 4 8h后分别检测血清PSA值 (放免法 )。　结果 :BPH伴急性尿潴留者血清PSA值为 (2 4 6± 16 1) μg/L(2 .6～ 4 5 .8μg/L) ,引流尿液 4 8h后血清PSA值降为(9.4± 6 .3) μg/L(1.7～ 16 .6 μg/L)。两者相比 ,差异有显著性 (P <0 .0 1)。 　结论 :急性尿潴留可使BPH病人血清PSA值显著升高。尿潴留缓解后 ,血清PSA值平均下降超过 5 0 %。     

Acute urinary retention in a child caused by a congenital bladder diverticulum

Acute urinary retention is an uncommon diagnosis in childhood, and is associated with a variety of causes. Congenital bladder diverticula, occurring almost exclusively in boys, is not a rare entity. However, acute urinary retention is an extremely rare complication of congenital bladder diverticulum. A boy with acute urinary retention caused by obstructing bladder diverticula is presented, and the surgical approach is discussed. J Pediatr Surg 37:926-927.     

Urinary retention in sickle cell syndromes

Four patients with sickle cell disease noted the development of urinary retention during an acute painful crisis. The acute urinary retention resolved with improvement in the painful sickle cell crisis. No evidence of anatomic urologic defect, systemic neurologic abnormality, or infection was documented in these patients. Patients with sickle cell disease in painful crisis should be observed for signs of acute urinary retention.     

Incidence rates and risk factors for acute urinary retention: the health professionals followup study.

PURPOSE: We define incidence rates and risk factors for acute urinary retention. MATERIALS AND METHODS: In 1992, 41,276 United States male health professionals 45 to 83 years old self-reported baseline health data and American Urological Association symptom index scores. In 1995 a subset reported the year of any episode of acute urinary retention requiring catheterization. Of 8,418 respondents 6,100 without a history of prostate cancer, prostatectomy or acute urinary retention before 1992 provided data. Incidence rates from 1992 to 1995 were calculated and risk factors were assessed using logistic regression. RESULTS: During 15,851 person-years of followup 82 men reported an episode of acute urinary retention (sampling weighted incidence 4.5/1,000 person-years, 95% confidence intervals 3.1 to 6.2). Rates increased with age and baseline symptom severity. In men with symptom score 0 to 7 (none or mild lower urinary tract symptoms) the incidence of acute urinary retention increased from 0.4/1,000 person-years for those 45 to 49 years old to 7.9/1,000 person-years for those 70 to 83 years old. In men with symptom score 8 to 35 (moderate or severe lower urinary tract symptoms) rates increased from 3.3/1,000 person-years for those 45 to 49 years old to 11.3/1,000 person-years for those 70 to 83 years old. Men with a clinical diagnosis of benign prostatic hyperplasia and a symptom score 8 or greater had the highest rates (age adjusted incidence 13.7/1,000 person-years). All 7 lower urinary tract symptoms comprising the American Urological Association symptom index individually predicted acute urinary retention (age adjusted odds ratio 1.8 to 2.9 for symptoms occurring more than 25% of the time during the last month). The sensation of incomplete bladder emptying, having to void again after less than 2 hours and a weak urinary stream were the best independent symptom predictors. Use of medications with adrenergic or anticholinergic side effects also predicted acute urinary retention. CONCLUSIONS: Acute urinary retention occurred relatively infrequently but older age, moderate or severe lower urinary tract symptoms, a diagnosis of benign prostatic hyperplasia and specific drug therapies significantly increased the risk of occurrence.     

Serum gamma-seminoprotein on patients suffering from urinary retention due to BPH]

Serum gamma-Seminoprotein (gamma-Sm) of 33 patients suffering from urinary retention due to BPH was evaluated. In acute urinary retention gamma-Sm was 17.1 +/- 54.9 ng/ml (N = 33) and its positive rate was 72.7%. After indwelling urethral catherization for one week gamma-Sm fell to 3.7 +/- 3.6 ng/ml (N = 17) and its positive rate was 42.8%. gamma-Sm measured after one month was negative on all cases. It was showed that gamma-Sm in acute urinary retention increased and after releasing from urinary retention it was rapidly normalized. It is necessary to take into account the above mentioned findings on evaluation of gamma-Sm as a tumormarker of prostatic carcinoma.     

Urinary retention following lower limb arthroplasty: analysis of predictive factors and review of literature

Acute urinary retention is a common complication after lower limb arthroplasty. The aim of our study was to assess whether the International Prostate Symptom Score (IPSS) and other patient related factors could predict the likelihood of patients developing urinary retention after lower limb arthroplasty. We have also reviewed the literature on this subject. This is a prospective study of 102 male patients undergoing hip or knee arthroplasty. Data collected included age, IPSS, type of operation, type of anaesthesia and development of acute urinary retention in the immediate postoperative period. Thirty-one patients (30.4%) developed acute urinary retention. Of all the parameters studied, age was the only factor that correlated significantly with development of urinary retention. The risk factors for progression of benign prostatic hyperplasia could all be considered as factors for the development of this complication. However, apart from age more than 70 years, it is not practical to use the other parameters.     

Urinary retention without organic cause in children

Acute urinary retention without organic explanation is well known in adults but has only rarely been described in children. Six cases (four boys and two girls) of non-organic acute urinary retention are reported. The diagnosis was based on negative findings on extensive urological examination. So-called psychogenic urinary retention in children is associated with constipation and infrequent voiding.     

Case of acute urinary retention as a result of non-steroidal anti-inflammatory drugs

Abstract:   A 19-year-old woman presented at our hospital with acute urinary retention in September 2005. She had experienced the same chief complaint twice previously. She had used non-steroidal anti-inflammatory drugs before acute urinary retention. The results of physical examinations were unremarkable, and her neurologic signs were not remarkable. The basic laboratory test values were all normal and a psychiatric assessment indicated that her symptoms were not psychogenic. Magnetic resonance imaging was carried out, but revealed only a slight bulging in the L3/L4/L5 disk. Water cystometry showed acontractile detrusor. We made a diagnosis of acute urinary retention as a result of non-steroidal anti-inflammatory drugs because of her use of such drugs before the development of symptoms on multiple occasions. This patient was regularly followed up as an outpatient, and she could void smoothly in February 2006. This is the first report which acute urinary retention associated with non-steroidal anti-inflammatory drugs in Japan.     

Bladder dysfunction after acute urinary retention in rats

PURPOSE: We investigated bladder function in acute urinary retention and subsequent catheterization in rat bladders. MATERIALS AND METHODS: The penile urethra in rats was clamped with a small clip and cystostomy was performed to infuse 3 ml. of saline for inducing acute urinary retention. At 30 minutes after the induction of urinary retention the cystostomy was opened to empty the bladder. In functional studies contractile responses to carbachol were measured in group 1-before, group 2-at 3 ml. of urinary retention, group 3-at 3 ml. of urinary retention exposed for 30 minutes and group 4-30 minutes after catheterization. Moreover, in vivo real-time monitoring of blood flow and vesical pressure were measured in the bladders with a laser Doppler flowmeter and cystometrography, respectively. Malonaldehyde and 4-hydroxyalkenals were measured by colorimetric assay in these groups. RESULTS: In functional studies the mean maximum contractile response value plus or minus standard deviation of carbachol-to-bladder in groups 1 to 4 was 11.8 +/- 1.3, 11.9 +/- 1.7, 9.8 +/- 0.8 and 6.9 +/- 0.7 gm./mm.2, respectively. In real-time monitoring of blood flow and vesical pressure acute urinary retention significantly decreased blood flow and increased vesical pressure, and subsequent catheterization increased blood flow and decreased vesical pressure in the bladders. The concentrations of malonaldehyde and 4-hydroxyalkenals in the bladders in group 4 were significantly higher than in the other groups. CONCLUSIONS: Our data indicate that bladder dysfunction after catheterization is partially caused by free radicals, which have an important role in bladder dysfunction during acute urinary retention.     

Does ultrastructural morphology of human detrusor smooth muscle cells characterize acute urinary retention?

PURPOSE: Acute urinary retention is relatively rare in otherwise healthy men. The condition may be attributable to a combination of obstruction and detrusor hypocontractility. We determined whether acute or chronic urinary retention is accompanied by characteristic ultrastructural features in bladder detrusor smooth muscle cells and whether any of these ultrastructural features may be useful for classifying these conditions. MATERIALS AND METHODS: Bladder biopsies of 15 men, including 13 in acute and 2 in chronic urinary retention, and 6 controls were examined by transmission electron microscopy. They were semiquantitatively and morphometrically analyzed for degenerative changes, cellular hypertrophy, variations in intercellular distances, abnormal cell junctions and configurations, and intracellular changes. RESULTS: No significant ultrastructural features were noted in the detrusor muscle of patients in acute urinary retention compared with controls. CONCLUSIONS: We cannot confirm the reports of others that characteristic ultrastructural features in smooth muscle cells accompany bladder outlet obstruction and detrusor hypocontractility.     

Acute urinary retention in herpes genitalis infection. Urodynamic evaluation

Acute urinary retention in herpes genitalis infection is reported to be infrequent. We report 4 cases of acute urinary retention caused by neurologic complication of herpes infection. The urodynamic finding and follow-up results are presented.     

Acute urinary retention following renal transplantation

The management of a renal transplant recipient who postoperatively developed acute urinary retention secondary to benign prostatic hypertrophy is discussed. The importance of a thorough urologic evaluation prior to renal transplantation is emphasized, especially in older male candidates. Should urinary retention occur following transplantation, temporary urinary diversion via suprapubic cystostomy should be employed until the patient is able to undergo prostatectomy.     

Efficacy of PSA in the detection of carcinoma of the prostate in patients presenting with acute urinary retention

OBJECTIVES: A temporary elevation in serum-prostate specific antigen (PSA) levels has been reported in association with acute urinary retention. In spite of this, it is not uncommon for clinicians to assay PSA at the time a patient presents with acute urinary retention. We sought to evaluate whether this practice can be justified. PATIENTS AND METHOD: Fifty-four patients, aged between 55 and 89 years, who presented to a single institution with acute urinary retention were studied. A PSA assay was performed on admission and a record made of the prostatic size as assessed by digital rectal examination. All patients underwent a trial without catheter, those that failed to void underwent prostatic surgery whilst all others were followed up as outpatients. RESULTS: Five patients were found to have prostatic carcinoma, three following transurethral resection of the prostate (TURP) and two following needle biopsy, performed because of persistent elevation of the PSA. A significant elevation in the PSA was associated with acute urinary retention, with only 15 (28%) patients having a PSA of 4.0 ng/ml or less. This elevation reduced the sensitivity of PSA in detecting carcinoma of the prostate; even with a cut-off of 20 ng/ml, the positive predictive value of the test was only 21%. CONCLUSIONS: A PSA assay should not be performed at the time of presentation with acute urinary retention as it may lead to unnecessary investigations and anxiety for the patient. For those in whom a PSA assay is desirable a delay of 2 weeks should be allowed prior to sampling, as the half-life of PSA is known to be 2-3 days.     

Effect of Postoperative Extradural Morphine on Lower Urinary Tract Function

The effect of postoperative extradurally administered morphine on lower urinary tract function was studied in female patients undergoing uterine surgery. Urodynamic measurements were made on the day before and on the day after the operation, using a DISA 2-channel carbon dioxide (CO2) cystomictrograph. In ten patients without postoperative urinary retention no changes in cystometry were found during morphine administration, while two patients who developed acute urinary retention had a marked increase in bladder capacity and of detrusor pressure. In contrast, the urethral pressure profile was unchanged in both groups of patients. Intravenously administered naloxone tended to normalize the bladder capacity in the patients with urinary retention. These findings seem to indicate a marked effect in some patients of extradurally administered morphine and the acute urinary retention, following morphine administration, may be treated with naloxone.