Episode Of Acute Urinary Retention Research Articles

SEMINAL VESICLE CYST PRESENTING WITH LOWER URINARY TRACT SYMPTOMS AND HUGE ABDOMINAL MASS

A 22-year-old man presented with urinary frequency, nocturia, dribbling, reduced force of urinary stream, an episode of acute urinary retention, and progressive constipation and abdominal mass 1 month in duration. Physical examination revealed an abdominal mass in the right suprapubic region without tenderness and mobility. Routine blood and urinary laboratory studies were normal. Sonography showed a solid hypoechoic, well-defined and homogeneous tumor between the bladder and rectum. There was no evidence of a right kidney. Films of the kidneys, ureters and bladder revealed increased pelvic density and spina bifida. Excretory urography demonstrated compensatory hypertrophy of the left kidney and mild left ureteral dilatation. The right kidney was not visible and the bladder was displaced with reduced volume (fig. 1). Transrectal ultrasonography showed a solid 132 3103 3 97 mm. mass in the pelvis presumed to be prostatic rhabdomyosarcoma. Casoni’s intradermal test and a hemagglutination inhibition test for hydatid cyst were negative. Abdominopelvic computerized tomography revealed a huge cystic mass with fine septations extending from the pelvic floor area, causing an indentation on the prostate and pushing the bladder anteriorly. Other organs were normal (fig. 2). On cystourethroscopy the urethra was visible and normal to the verumontanum but because of anterior displacement and elevation of the bladder neck, rigid cystoscopy was impossible. Retrograde cystourethrography showed a normal anterior urethra but the posterior urethra was elongated, compressed and distorted anteriorly, and the bladder was displaced. At surgical exploration there was a thick walled cystic lesion in the posterior retroperitoneum, adhering to the bladder and to both vas deferens, which was excised. The origin of cyst was the right seminal vesicle. The cyst contained homogeneous and brownish liquid. Histologically, the fluid had high protein content, and cytology showed red blood cells, lymphocytes, histiocytes and neutrophils. On pathological examination there was a fibrotic capsule with muscular and nerve fibers with no evidence of malignancy and no definite epithelial lining. The origin was probably the bladder or seminal vesicle. The patient was well when discharged home and had normal voiding function. DISCUSSION

Urinary Retention in Patients with BPH Treated with Finasteride or Placebo over 4 Years

Objectives: Knowledge regarding the incidence and prevalence of acute urinary retention and the ultimate outcome is very limited. The purpose of the present analysis was to document the natural history and outcomes of acute urinary retention (AUR) further specified as being either precipitated or spontaneous, and to evaluate the potential benefit of finasteride therapy.Materials and Methods: Three thousand and forty men with moderate to severe symptoms of BPH and enlarged prostate glands by digital rectal examination were enrolled into the 4–year placebo–controlled PLESS trial and were evaluated for occurrences of AUR and BPH–related surgery. Men in the study were seen every 4 months; discontinued patients were followed up 6 months after discontinuation and again at the end of the 4–year trial. Complete 4–year data on outcomes (occurrence of AUR or BPH–related surgery) was available for 92% of the enrolled subjects in each treatment group. An endpoint committee, blinded to treatment group and center, reviewed and categorized all study–related documentation relating to retention and surgery.Results: Over the 4–year period, 99 of 1,503 placebo–treated patients (6.6%) experienced one or more episodes of AUR in comparison with 42 or 1,513 finasteride–treated patients (2.8%; p<0.001). Approximately half of the episodes of retention were spontaneous and clearly BPH–related, while the other episodes were precipitated by another factor (PAUR). After spontaneous AUR, subsequent surgery was performed in 39 of 52 (75%) placebo–treated patients versus 8 of 20 (40%) finasteride–treated patients (p = 0.01). BPH–related surgery was less common in men who had a prior episode of PAUR (26% in the placebo group and 14% in the finasteride group).Conclusion: There is a continual risk of spontaneous and precipitated acute urinary retention in men with moderate to severe lower urinary tract symptoms and an enlarged prostate gland. Fewer patients who developed precipitated AUR than spontaneous AUR go on to need subsequent BPH–related surgery. Significantly fewer finasteride–than placebo–treated patients developed AUR, and among those men, fewer ultimately needed BPH–related surgery.

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 rate 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-year). 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.

PROTEINURIA AND RENAL FUNCTION DURING AND AFTER ACUTE URINARY RETENTION

Purpose Benign prostatic hyperplasia is the most common neoplasm as well as the main cause of bladder outlet obstruction in men. It may progress to involve a risk of urinary retention. We investigated the effects of acute urinary retention on renal function. Materials and Methods We evaluated renal function using biochemical markers in 25 men with a mean age of 69 years in whom an episode of acute urinary retention a mean of 31 hours in duration was due to bladder outlet obstruction. Patients were followed for 6 months after acute retention was relieved. Patients were not known to have had any renal disease previously. Results During acute urinary retention at presentation, and after 1 and 6 months we noted albuminuria in 100, 92 and 54% of patients, elevated alpha 1-microglobulin excretion in 54, 39 and 58%, and elevated beta 2-microglobulin excretion in 17, 19 and 9%. Serum creatinine or creatinine clearance did not predict proteinuria. All parameters became normal at 6 months in only 2 cases. Conclusions Acute urinary retention affects glomerular and tubular renal function. After acute urinary retention was relieved increased glomerular permeability and tubular damage persisted in the majority of patients. This condition may have been partially due to previous long-term bladder outlet obstruction. Our findings stress the importance of the rapid recognition and treatment of acute urinary retention.

ACUTE URINARY RETENTION DUE TO AN IATROGENIC BLADDER DIVERTICULUM

A 27-year-old man was referred to our institution after 3 episodes of acute urinary retention during a 6-month period. With each episode of urinary retention the patient reported mid abdominal pain, catheterization yielded greater than 400 cc of urine and he was able to void normally without discomfort following drainage. The patient denied any other genitourinary problems. History was remarkable only for left inguinal herniorrhaphy at age 17 years and laparoscopic repair of a recurrent left inguinal hernia 8 years later. All FIG. 2. Diverticulum histology. Reduced from ~ 4 0

Natural History of Prostatism: Risk Factors for Acute Urinary Retention

Purpose We determined the occurrence of and risk factors for acute urinary retention in the community setting. Materials and Methods A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire that assessed symptom severity, and voided into a portable urometer to measure peak urinary flow rates. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume. Followup was performed through a retrospective review of community medical records to determine the occurrence of acute urinary retention in the subsequent 4 years. Results During the 8,344 person-years of followup 57 men had a first episode of acute urinary retention (incidence 6.8/1,000 person-years, 95% confidence interval [CI] 5.2, 8.9). Among men with no to mild symptoms (American Urological Association symptom index score 7 or less) the incidence of acute urinary retention increased from 2.6/1,000 person-years among men 40 to 49 years old to 9.3/1,000 person-years among men 70 to 79 years old. By contrast, rates increased from 3.0/1,000 person-years for men 40 to 49 years old to 34.7/1,000 person-years among men 70 to 79 years old among men with moderate to severe symptoms (American Urological Association symptom index score greater than 7). Men with depressed peak urinary flow rate (less than 12 ml. per second) were at 4 times the risk of acute urinary retention compared with men with urinary flow rates greater than 12 ml. per second (95% CI 2.3, 6.6). Men with an enlarged prostate (greater than 30 ml.) experienced a 3-fold increase in risk (95% CI 1.0, 9.0, p = 0.04). Conclusions Lower urinary tract symptoms, depressed peak urinary flow rates, enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men. These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted.

Genitourinary neurofibromatosis mimicking posterior urethral valves

A 12-year-old boy, examined after an episode of acute urinary retention, was found to have neurofibromatosis of the bladder neck and prostatic urethra. His symptoms of bladder outlet obstruction and radiographic findings of a dilated prostatic urethra mimicked posterior urethral valves. Complete urologic investigation, including cystourethroscopy, revealed that the dilatation of the prostatic urethra was secondary to neural involvement of the external sphincter and posterior urethra without mechanical obstruction or posterior urethral valves.

The necessity of voiding cystourethrogram in the pretransplant urologic evaluation

Objectives To determine the efficacy of limited use of voiding cystourethrogram (VCUG) in the evaluation of patients for renal transplantation. Methods A retrospective review of 439 patients who underwent renal transplantation between October 1983 and May 1995; however, since September 1993 we used VCUC selectively in the pretransplant evaluation. Results Since September 1993, only 51 % of our renal transplant patients had a VCUG as part of their pretransplant evaluation. Only one urologic complication has occurred in a 68-year-old man with a history of glomerulonephritis. He had an episode of acute urinary retention, which was treated successfully with a temporary suprapubic tube followed by medical therapy. Conclusions Our preliminary results reveal no adverse outcomes associated with the selective use of VCUG in the pretransplant evaluation, and indicate that this study is of little value in the routine evaluation of these patients.

Urinary retention secondary to ovarian dysgerminoma in a girl

A thirteen-year-old girl sought medical advice because of a markedly weakened urinary stream with severe hesitancy. She was referred to the pediatric clinic because of 3 episodes of acute urinary retention during a previous month. Pelvic examination showed a retrovesical tumor. An excretory urogram revealed bilateral ureterectasis and pyelocalicectasis. Two weeks after left nephrostomy, surgical exploration demonstrated a right ovarian mass causing compression of the left ureter and obstruction of the bladder neck. Excision of the tumor was performed without difficulty, following which the patient resumed normal voiding. The resected tumor weighed 815 Gm and pathologic examination showed dysgerminoma. Postoperatively the following two and one half years were uneventful.

Urodynamic Changes Following Removal of a Large Ovarian Cyst

We describe the case of a young woman who presented with recurrent episodes of acute urinary retention due to a large ovarian cyst. She was found to have detrusor instability and vesical diverticula. Following removal of the cyst, the urodynamic behaviour and radiological appearance of her bladder returned to normal.