Abstract
ObjectivesTo understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters.Materials and Methods56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used.ResultsAll patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up.ConclusionsRecovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.
Highlights
Diminished independence of hospitalized older people is associated with an increased risk of transfer to nursing homes, mortality and healthcare costs after hospital discharge [1].Patients resting or immobilized in hospital beds are a common clinical situation in different disease states
Our study showed new improvement in mobility indexes after 7 days at home in a continuum of the recovery of spontaneous voiding, possibly suggesting that aside from the greater clinical improvement in the primary disease, returning to the familiar environment may contribute to more frequent and a wider amplitude of movements than those of the restrictive hospital environment
We observed only a partial recovery of the lower limbs, confirming the results of other studies in which 30% of patients treated for acute illness lost the ability to perform ADL compared to pre-admission levels [8]
Summary
Patients resting or immobilized in hospital beds are a common clinical situation in different disease states. Frail older patients more commonly experience bed restriction during their recovery from the primary disease due to established generalized weakness or loss of consciousness [2]. Restoration of spontaneous voiding is a stressful event in the hospital setting because it can hardly be predicted, extending the period of undesired hospitalization even after general clinical improvement. We hypothesized that diminished leg activity due to bed restriction secondarily predisposes patients to AUR resulting from the impaired neurogenic input from the neural sacral roots and poorly understood neurotrophic factors. Restoration of spontaneous voiding after a period of bed rest may be parallel to the functional recovery of the lower limbs
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