Acute Urinary Retention Group Research Articles

Efficacy and durability of holmium laser enucleation of the prostate in the management of acute and chronic urinary retention A retrospective study.

Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR >300 mL in males able to void; and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. HoLEP is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

The effect of acute urinary retention on the results of transurethral resection of the prostate.

Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.

Occurrence and Risk Factors for Acute Urinary Retention and Urinary Tract Infection in Patients Undergoing Urinary Drainage after Colorectal Resection.

This study aimed to explore the occurrence of acute urinary retention (AUR) and urinary tract infection (UTI) in patients undergoing urinary drainage after colorectal resection and analyse the risk factors. Clinical data of 167 patients with urinary drainage after colorectal resection in Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital from November 2020 to November 2022 were retrospectively analysed. Clinical data included age, gender, diabetes, hypertension, lesion location, surgical method, previous history of abdominal surgery, urinary system diseases (urinary calculi, benign prostatic hyperplasia and urethral stricture), use of antibiotics before surgery, use of analgesic and sedative drugs after surgery, postoperative extubation time and postoperative adhesive intestinal obstruction. The postoperative AUR and UTI in patients were statistically analysed. Univariate and multivariate logistic regression analyses were used to explore the risk factors and odds ratio (OR) for AUR and UTI. The incidences of AUR and UTI were 23.95% (40/167) and 16.77% (28/167). Patients were divided into AUR group (n = 40), non-AUR group (n = 127), UTI group (n = 28) and non-UTI group (n = 139). Logistic regression analysis showed that previous history of abdominal surgery (OR = 3.517, 95% CI: 1.005-12.313), urinary system diseases (OR = 8.253, 95% CI: 2.692-25.303), postoperative extubation time (OR = 0.536, 95% CI: 0.393-0.732) and postoperative adhesive intestinal obstruction (OR = 25.293, 95% CI: 6.747-94.827) were risk factors for AUR in patients with urinary drainage after colorectal resection (p < 0.05). Female (OR = 21.569, 95% CI: 1.094-425.138), long postoperative extubation time (OR = 26.218, 95% CI: 3.318-207.151) and urinary system diseases (OR = 8.647, 95% CI: 3.425-21.831) were risk factors for UTI in patients undergoing urinary drainage after colorectal resection (p < 0.05). Age and preoperative use of antibiotics were not key influencing factors for UTI (p > 0.05). Clinical attention is paid to high-risk factors and groups. Corresponding interventions are taken as soon as possible to reduce the occurrence of AUR and UTI and further improve the prognosis of patients with urinary drainage after colorectal resection.

Comparative Evaluation of Post-TURP Complications in Patients with BPH Presenting with and Without Acute Urinary Retention

AbstractBackground Benign prostatic hyperplasia (BPH) is a prevalent urological condition affecting men at an older age. Acute urinary retention (AUR) is a severe symptom of men who develop BPH. TURP is the gold standard as the management of BPH is concerned. Our study tried to compare the post-TURP complications between patients presented with and without AUR.Materials and Methods We enrolled 126 patients, out of which 74 were in the AUR group and 52 in the non-AUR group. The mean age of patients with AUR was 62.51 years, and that for patients without AUR was 61.06 years. Statistical significance was noted in our study in patients with AUR and without AUR regarding the prostate's grading by DRE, the volume of gland, PSA level, post-TURP UTI, recatheterization post TURP, length of hospital stays with p-values 0.000, 0.000, 0.006, 0.004, 0.007, and 0.000, respectively. Statistical significance was not noted in patients with AUR and without AUR with regard to the grading of hypertension, diabetes mellitus, ischemic heart disease, post-op TURP syndrome, post-TURP hematuria, patients needing a blood transfusion, post-TURP sepsis, LUTS, post-TURP stricture, resurgery for clot retention with p values of 0.918, 1.000, 1.000, 1.000, 0.523, 0.642, 1.000, 0.319, 1.000, and 1.000, respectively.Conclusion Our study shows that post-TURP complications such as hematuria, blood transfusion rate, post-op UTI, sepsis, recatheterization, lower urinary tract stricture, resurgery, TUR syndrome, and the length of hospital stay were higher in patients who presented with AUR than in those without AUR. Post-TURP UTI complications, recatheterization rate, and the length of hospital stay were statistically significant in the AUR group compared with the non-AUR group. Therefore, it is better to intervene earlier before the patients develop AUR to minimize the complications and maximize the outcomes.

MP09-04 iTind FOR THE TREATMENT OF LUTS SECONDARY TO BPH IN POLYMORBID PATIENTS: THOSE IN ACUTE URINARY RETENTION AND ON ANTI-COAGULANTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-04 iTind FOR THE TREATMENT OF LUTS SECONDARY TO BPH IN POLYMORBID PATIENTS: THOSE IN ACUTE URINARY RETENTION AND ON ANTI-COAGULANTS Gregor Kadner, Karl Rohrmann, Gabriel Schell, Philipp Baumeister, and Thomas Herrmann Gregor KadnerGregor Kadner More articles by this author , Karl RohrmannKarl Rohrmann More articles by this author , Gabriel SchellGabriel Schell More articles by this author , Philipp BaumeisterPhilipp Baumeister More articles by this author , and Thomas HerrmannThomas Herrmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aim of our study was to assess the outcomes of treatment of LUTS secondary to BPH with temporary implantable nitinol device (iTind; Medi-Tate Ltd, Israel), in patients with multiple comorbidities that put them at increased risk for TURP: acute urinary retention (AUR), anti-coagulation therapy (ACT) and under active surveillance for prostate cancer (AS). METHODS: We conducted a retrospective analysis of 20 consecutive patients treated with the iTind System at a single center between May 2015 and October 2019. Follow-up was between 6 to 42 months, patients had an average age of 63.9 (47-81), average prostate volume of 57.45ml (21ml – 92ml), mean Charlson Comorbidity Index of 6.35. 12 patients were receiving anticoagulants, 11 patients were in retention (AUR), and 5 were under active surveillance for prostate cancer. iTind was implanted under light sedation and removed 5-7 days later in all patients. In patients with AUR an suprapubic cystostomy was placed additionally or patients stayed on Foley. Functional results, ability to void spontanously, IPSS, Qmax and PVR were assessed at follow-up points. RESULTS: All implantation procedures were successfully completed with no perioperative complications. Significant reductions in IPSS and increases in Qmax were observed among all patient groups. Sexual function was preserved in all patients. In the AUR group 11 out of 12 patients were able to void with significant reductions in PVR over time. Only 5 post-operative adverse events were reported in 3 patients. 2 patients reported pain and urgency during implantation period, which resolved upon device removal. 1 bleeding complication requiring transurethral coagulation was reported in one patient, a wheelchair bound double leg amputee on ACT. This was likely due to prolonged static sitting on the device. No other bleeding complications were observed in the ACT patient group or any other patient group. 4 patients underwent TURP (3 from the AUR group): 1 after 3.5yrs, 2 after 2.5yrs and 1 after 1yr of follow-up. CONCLUSIONS: iTind demonstrated to be a safe and effective solution for patients reluctant or at high risk for undergoing a traditional surgical procedure as the result of multiple comorbidities. iTind does not seem to pose an additional bleeding risk for anti-coagulated patients and may provide an effective treatment for patients in complete urinary retention. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e160-e161 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregor Kadner More articles by this author Karl Rohrmann More articles by this author Gabriel Schell More articles by this author Philipp Baumeister More articles by this author Thomas Herrmann More articles by this author Expand All Advertisement Loading ...

Serum interleukin 6 and acute urinary retention in elderly men with benign prostatic hyperplasia in China: a cross-sectional study.

BackgroundWhile acute urinary retention (AUR) is a severe complication of benign prostatic hyperplasia (BPH), it can also indicate the progression of this common disease in aging men. This study aimed at exploring the possible relationship between serum interleukin 6 (sIL-6) and AUR in BPH patients.MethodsA cross-sectional study was conducted based on 256 elderly men with BPH in China. The association between the sIL-6 level and the occurrence of AUR was evaluated by univariate and multivariable logistic regressions. The receiver operating characteristic (ROC) curve was utilized to determine the discriminant validity of the sIL-6 level and the optimal cut-off value.ResultsThe concentration of sIL-6 was significantly elevated in the AUR group (P<0.001). A positive correlation was observed between the sIL-6 level and AUR in BPH patients [odds ratio (OR) =1.365, 95% confidence interval (CI): 1.174–1.586, P<0.001]. Based on the ROC curve analysis for sIL-6, the optimal cut-off point of 4.475 pg/mL was set to identify the occurrence of AUR in these patients [area under the curve (AUC) =0.7596, 95% CI: 0.6976–0.8216, P<0.001]. A high sIL-6 level (≥4.475 pg/mL) had a significantly stronger correlation with AUR (OR =9.666, 95% CI: 4.347–21.491, P<0.001).ConclusionsThere was a positive correlation between the sIL-6 level and the occurrence of AUR in elderly Chinese patients with BPH. This study provides potential strategies for the screening of BPH individuals with a possible risk of AUR, which may contribute to the early implementation of effective interventions to improve the quality of life and prognosis. Long-term prospective studies are still required to further illustrate the causal relationship.

Effects of sacral nerve stimulation on postpartum urinary retention-related changes in rat bladder

ObjectiveTo examine the effect of sacral nerve stimulation (SNS) on the urodynamic function and molecular structure of bladders in rats following acute urinary retention (AUR) after parturition. Material and methodsThirty primiparous rats were divided into three groups: postpartum, postpartum+AUR, and postpartum+AUR+SNS. AUR was achieved by clamping the distal urethra of a rat for 60 minutes. The postpartum+AUR+SNS group received electrical stimulation 60 minutes daily for 3 days after AUR. In addition to cystometric studies and external urethral sphincter electromyography, the expression of caveolins and nerve growth factor (NGF) and caveolae number in bladder muscle were analyzed. ResultsThe postpartum+AUR group has significantly greater residual volume than the postpartum group, but the residual volume decreased significantly after SNS treatment. The postpartum+AUR group had significantly lower peak voiding pressure, a longer bursting period and lower amplitude of electromyograms of external urethral sphincter activity than the postpartum and postpartum+AUR+SNS groups. The postpartum+AUR rats had higher NGF expression, lower caveolin-1 expression, and fewer caveolae in bladder muscle compared with the postpartum rats. Conversely, the caveolin-1 expression and caveolae number increased, and the NGF expression decreased after SNS treatment. ConclusionBladder dysfunction after parturition in a rat model caused by AUR may be restored to the non-AUR structural and functional level after SNS treatment.

The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention.

In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR). We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR (n = 348) and non-AUR groups (n = 778). After the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P < 0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P < 0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P < 0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3–12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.

PD27-08 REAL WORLD RETENTION RATES AFTER INTRAVESICAL ONABOTULINUMTOXINA FOR IDIOPATHIC OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Incontinence - Therapy I1 Apr 2015PD27-08 REAL WORLD RETENTION RATES AFTER INTRAVESICAL ONABOTULINUMTOXINA FOR IDIOPATHIC OVERACTIVE BLADDER Olufenwa Milhouse, Marta Johnson, Leah Gross, and Steven Siegel Olufenwa MilhouseOlufenwa Milhouse More articles by this author , Marta JohnsonMarta Johnson More articles by this author , Leah GrossLeah Gross More articles by this author , and Steven SiegelSteven Siegel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of idiopathic overactive bladder (OAB) is 12-19%. Among the list of third line therapies include intravesical onabotulinumtoxinA (iBTXA). Analysis from two large phase III clinical trial demonstrated a 6.5% incidence of acute urinary retention (AUR) requiring catheterization (CIC). However, other studies have demonstrated a higher incidence of AUR, ranging from 5-35%. Our primary objective is the incidence of AUR requiring CIC after initial iBTXA for idiopathic OAB and to evaluate factors that may predict AUR after iBTXA. METHODS Medical records were reviewed from patients undergoing initial iBTXA since 2010. Patients with a diagnosis of interstitial cystitis or neurogenic detrusor overactivity (NDO) were excluded. Primary objective was overall incidence of AUR requiring CIC. Factors analyzed by logistic regression to determine association with AUR include age, gender, diagnosis of diabetes, baseline post void residual (PVR), presence of urodynamic detrusor overactivity (DO), bladder capacity, peak flow rate (Qmax), and BTXA dose. RESULTS A total of 292 patients underwent initial iBTXA using between 2010 and 2014. Excluding NDO and those without follow up, 103 patients were analyzed. Overall incidence of CIC was 25.2%. In 5 of these patients, postoperative PVR was < 200 mL; excluding them, the incidence of AUR was 20.4%. Of these, 24% were male versus 21% in non-retention (non-AUR) patients. Diabetics made 24% and 17% of the retention (AUR) and non-AUR group respectively. Mean age, proportion with DO, bladder capacity, and Qmax were similar. Baseline PVR was similar at 30 and 34 mL in the AUR and non-AUR group respectively. The 200unit dose was used in 19% and 11% in the AUR and non-AUR group respectively. Mean postoperative PVR was 269 mL and 80.5 mL in the AUR and non-AUR group respectively. Overall incidence of UTI was 30%; 62% in the AUR versus 22% in the non-AUR group (p = 0.0012). Despite AUR, over 40% of patients continued with a second iBTXA. On logistic regression, no variable was associated with the risk of AUR requiring CIC due to small sample size. CONCLUSIONS Our overall incidence of AUR requiring CIC is 30%. Standardization of AUR definition and further investigation into the specific risk factors are needed to more accurately counsel patients considering iBTXA. Characteristics of Total study population, non-retention and retention groups Characteristic Total population Non-retention Retention P-value No. of patients (%) 103 (100) 82 (79.6) 21 (20.4) Age (years) 68 ± 16 68 ± 16 68 ± 16 0.983 No. male patients (%) 22 (21.4) 17 (20.7) 5 (23.8) 0.7696 Diabetes (%) 19 (18.4) 14 (17.1) 5 (23.8) 0.5311 Bladder capacity (mL) 278 ± 166 278 ± 166 284 ± 170 1.000 Qmax (mL/s) 17 ± 10 17 ± 10 16 ± 11 0.913 No. with Detrusor overactivity (%) 89 (86.4) 57 (69.5) 15 (71.4) 0.8644 Preoperative PVR (mL) 33 ± 36 34 ± 38 30 ± 30 0.614 No of BTXA dose: 200 units (%) 13 (12.6) 9 (11) 4 (19) 0.4595 Postoperative PVR (mL) 115 ± 102 81 ± 76 269 ± 41 < 0.0001 PVR change 89 ± 107 51 ± 80 240 ± 46 < 0.0001 No. of Culture-proven UTI (%) 31 (30) 19 (22.3) 13 (62) 0.0012 Mean± SD © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGinsberg D (2018) OnabotulinumtoxinA is Preferred over Sacral Neuromodulation for Refractory Overactive BladderJournal of Urology, VOL. 197, NO. 1, (11-13), Online publication date: 1-Jan-2017. Volume 193Issue 4SApril 2015Page: e574 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Olufenwa Milhouse More articles by this author Marta Johnson More articles by this author Leah Gross More articles by this author Steven Siegel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Preoperative Urinary Retention Increased the Risk of Urinary Retention after Photoselective Vaporization of the Prostate.

PurposeThe aim of the present study was to evaluate preoperative acute urinary retention (AUR) as a factor affecting the outcomes of patients who underwent photoselective vaporization of the prostate (PVP), both in terms of overall effectiveness and the postoperative incidence of AUR.Materials and MethodsBaseline prostate characteristics were obtained for patients who underwent PVP, including prostate-specific antigen (PSA) levels, transrectal ultrasound findings, voiding diary parameters, the International Prostate Symptoms Score (IPSS), and uroflowmetry parameters. These parameters were assessed two weeks, one month, three months, six months, and three years postoperatively. Subjects were divided into AUR and non-AUR groups based on the preoperative occurrence of AUR.ResultsOf the 476 patients, 91 had at least one episode of preoperative AUR. The AUR group was found to be significantly older and to have significantly higher PSA levels, lower body mass indices, and larger prostates. At one year of follow-up, the total IPSS was 7.6±6.8 in the AUR group and 11.4±8.2 in the non-AUR group, with the AUR group showing a more significant improvement. In the non-AUR group, 17 of the 385 patients (4.4%) experienced postoperative retention, compared to 16 of the 91 patients (17.6%) patients in the AUR group.ConclusionsAlmost all patients exhibited improvements in subjective and objective voiding parameters following PVP, regardless of the presence of preoperative urinary retention. Patients with a preoperative history of AUR had a higher risk of postoperative retention.

How antepartum and postpartum acute urinary retention affects the function and structure of the rat bladder

To examine the effect of acute urinary retention (AUR) on the urodynamic function and molecular structure of rat bladders in pregnancy and after parturition. Forty-eight nulliparous rats were distributed into AUR and non-AUR groups. AUR was induced by clamping the distal urethra of each rat after infusing 3 ml of saline for 60 min. Plasma progesterone levels and cystometric data were evaluated on the 14th day of gestation, 3 and 10 days postpartum, and in virgin rats. The immunoreactivity of caveolins and nerve growth factor (NGF) was analyzed. The number of caveolae in bladder muscle cells was evaluated by electron microscopy. Progesterone levels significantly increased during pregnancy and 3 days postpartum. In cystometric results, the AUR group has significantly shorter intercontraction interval, lower void volume and greater residual volume compared with the non-AUR. AUR rats exhibited higher NGF immunoreactivity, lower caveolin-1 immunoreactivity, and less caveolae in the bladder compared with the non-AUR. The caveolin-1 and NGF immunoreactivity and the number of caveolae in the bladder decreased during pregnancy and 3 days postpartum compared with virgin rats. By using Pearson correlations, we found significant correlations between urodynamic variables (residual volumes and intercontraction intervals) and the expressions of caveolin-1, caveolae and NGF in the AUR rats on the 14th day of gestation and 3 days postpartum. Bladder dysfunction in pregnancy and immediately postpartum in a rat model caused by AUR is associated with the plasma progesterone level change and the expressions of caveolin, caveolae, and NGF in bladder muscle cells.

Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population‐based study

Study Type--Prognosis (cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Higher mortality and morbidity rates in men presenting with AUR have been reported in previous studies. This study has comprehensive comparisons of post-TURP complications between patients with and without AUR. Furthermore, it shows that AUR is associated with increased risk of complications after TURP. • To assess the association between a history of acute urinary retention (AUR) and complications after transurethral resection of prostate (TURP). • We conducted a retrospective, national, population-based study using Taiwan's National Health Insurance Research Database. • We included men > 50 years old, diagnosed with benign prostatic hyperplasia (BPH) and divided these into two groups: an AUR(+) group--those with AUR who underwent TURP between 2002 and 2004; and an AUR(-) group--those without AUR who underwent TURP between those dates. • Prostate cancer, Parkinsonism and multiple sclerosis were exclusion criteria. • Postoperative complications, e.g. re-catheterization, haematuria or urinary tract infection (UTI), were compared using crude odds ratios (ORs), 95% confidence intervals (CIs), and Student's t-test. • A chi-squared test was used for potential confounding factors: preoperative UTI and anticoagulant use. • Univariate and multivariate analysis on medical expenses were conducted. • The AUR(+) group contained 3305 men; the AUR(-) group contained 1062. • Re-catheterization (13.8%), septicaemia (1.1%) and shock (0.3%) were found only in the AUR(+) group. • The AUR(+) group had more UTIs (18.9% vs. 15.6%, OR: 1.26, 95% CI: 1.05-1.52), more lower urinary tract symptoms (22.8% vs. 16.9%, OR: 1.45, 95% CI: 1.21-1.73), fewer blood transfusions (3.2% vs. 1.5%, OR: 2.19, 95% CI: 1.29-3.72) and higher medical expenses. • There were no significant differences in haematuria, lower urinary tract stricture, or re-surgical intervention of the prostate and second-line antibiotic use. • Patients in Taiwan with BPH with AUR who were treated by TURP were associated with a higher risk of complications, longer hospital stay and more comorbidities than those without AUR and a preoperative warning is warranted for these patients.

Pharmacological preconditioning of ATP-sensitive potassium channel openers on acute urinary retention-induced bladder dysfunction in the rat

What's known on the subject? and What does the study add? Acute urinary retention (AUR) and catheterization for AUR (AURC) or drainage of the urine is a well established cause of bladder dysfunction. Previously, we reported that the induction of AURC significantly reduced contractile responses to both carbachol and KCl compared with a control group, and that this reduction was prevented by nicorandil and cromakalim in a dose-dependent manner; however, although we reported a possible beneficial effect of nicorandil and cromakalim on bladder dysfunction caused by AURC, its molecular mechanism is still unknown. Our study establishes that nicorandil and cromakalim, but not glibenclamide, prevent AURC-induced bladder dysfunction via up-regulation of both K(IR)6.1 and K(IR)6.2 with a subsequent decrease in oxidative stress and decreased induction of apoptosis in the bladder. To investigate whether ATP-sensitive potassium (K(ATP)) channel openers prevent bladder injury after acute urinary retention (AUR) and subsequent catheterization for AUR (AURC) in the rat. Eight-week-old male Sprague-Dawley rats were divided into five groups: a sham-operated control group, an AUR group, and three AUR groups treated with: nicorandil (10 mg/kg); cromakalim (300 µg/kg); or glibenclamide (5 mg/kg). AUR was induced by intravesical infusion of 3.0 mL of saline via cystostomy with simultaneous clamping of the penile urethra and, after 30 min of AUR, the bladder was allowed to drain for 60 min. After the experimental period, bladder function was assessed using organ bath techniques (carbachol and KCl), and by measuring tissue levels of 8-isoprostane, a marker of oxidative stress. The participation levels of K(ATP) channel pores were investigated using ELISA and real-time PCR methods, respectively. The degree of apoptosis was estimated using the TUNEL method in the bladder smooth muscle and epithelium. The AURC group showed significantly decreased contractile responses to carbachol and KCl, and significant increases in tissue 8-isoprostane levels and apoptosis index in the epithelium compared with the control group. Nicorandil and cromakalim, but not glibenclamide, significantly prevented these AURC-induced alterations. The expressions of K(IR)6.1 and K(IR)6.2 mRNAs were significantly up-regulated by the induction of AURC. Nicorandil and cromakalim, but not glibenclamide, significantly up-regulated expressions of K(IR)6.1 and K(IR)6.2 mRNAs in the bladder compared with the AUR group. Our data indicate that nicorandil and cromakalim, but not glibenclamide, prevent AURC-induced bladder dysfunction via activation of K(ATP) channels, with a subsequent decrease in oxidative stress and decreased induction of apoptosis.

Analysis of the Treatment of Two Types of Acute Urinary Retention

PurposeThis study analyzed the type of acute urinary retention (AUR) and evaluated the treatments used, including trial without catheter (TWOC).Materials and MethodsThis study was based on 299 patients who were treated for AUR from January 2007 to August 2009. The patients were classified into the spontaneous AUR group (group S) and the precipitated AUR group (group P), in which AUR was consecutive to triggering events. The treatment modalities including TWOC, the success rate of TWOC, age, prostate-specific antigen (PSA) levels, the volume of the prostate, and the drained volume at catheterization were analyzed in each group.ResultsOf 299 men with AUR, 160 (54%) had spontaneous AUR and 139 (46%) had precipitated AUR. Compared with group P, patients in group S were more likely to be treated by surgery, either immediately (16.9% vs. 3.6%, p<0.05) or after prolonged catheterization (42.2% vs. 29.1%, p<0.05). The success rate of TWOC was lower in men of older ages (≥70 years) and in those with enlarged prostates (≥50 ml), higher PSA levels (≥3 ng/ml), and a large drained volume at catheterization (≥1,000 ml).ConclusionsIn this group of AUR patients, there were slightly more patients with spontaneous AUR (54%) than with precipitated AUR (46%). The success rate of TWOC was more than 70% regardless of the type of AUR. Although TWOC is recommended primarily in the treatment of AUR, early surgical intervention should be considered if the patient has an enlarged prostate (≥50 ml) or a large drained volume at catheterization (≥1,000 ml).

1580 IMPACT OF PROSTATE SPECIFIC ANTIGEN, PROSTATIC SIZE AND HISTOPATHOLOGY ON ACUTE URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research1 Apr 20111580 IMPACT OF PROSTATE SPECIFIC ANTIGEN, PROSTATIC SIZE AND HISTOPATHOLOGY ON ACUTE URINARY RETENTION Huseyin Cihan Demirel, Cevdet Serkan Gökkaya, Cuneyt Ozden, Binhan Kagan Aktas, Suleyman Bulut, and Ali Memis Huseyin Cihan DemirelHuseyin Cihan Demirel Ankara, Turkey More articles by this author , Cevdet Serkan GökkayaCevdet Serkan Gökkaya Ankara, Turkey More articles by this author , Cuneyt OzdenCuneyt Ozden Ankara, Turkey More articles by this author , Binhan Kagan AktasBinhan Kagan Aktas Ankara, Turkey More articles by this author , Suleyman BulutSuleyman Bulut Ankara, Turkey More articles by this author , and Ali MemisAli Memis Ankara, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1616AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The most common cause of obstructive acute urinary retention (AUR) is benign prostatic hyperplasia (BPH). For investigating the aetiology of AUR elaborately, we evaluated the relationship between AUR and its different aetiologic factors such as patient age, prostate specific antigen (PSA) level, prostatic size and histopathology. METHODS Between January and December 2008, two hundred and twenty six patients who underwent transurethral resection of prostate (TURP) procedure due to AUR or lower urinary tract symptoms (LUTS) were included in the study. Patients were classified into two groups; namely AUR and LUTS groups. AUR group consisted of 89 (39.38%) and LUTS group 137 (60.62%) patients. AUR group included the patients in whom catheterization required due to bladder distention for the first time in their lives. Two groups were compared in respect to patient age, prostatic size, histopathology and PSA level for determining the possible impact of AUR on these parameters. Pearson's chi-square and Mann-Whitney U tests were applied and p values under 0.05 were considered as significant. RESULTS The mean age of AUR group was significantly higher than LUTS group (p<0,0001). The mean PSA level of AUR group was higher than LUTS group but that was not significant (p=0,089). The greater the size of prostate, the greater the risk of getting AUR. Thus the mean weight of resected prostatic tissue was higher in AUR group than LUTS group (p=0.031) (Table 1). Table 1. Patient characteristics (mean±SD) (min-max) All patients (n=226) AUR group (n=89) LUTS group (n=137) p value⁎ Age (year) 67,7±7,7(38-84) 70,1±6,1(59-84) 66,1±8,2(38-84) >0,0001 PSA level (ng/ml) 6,45±4,97(0,6-20) 7,6±5,15(0,6-20) 5,54±4,7(0,8-16) 0,089 Weight of resected prostatic tissue (gr) 25,47±21,77(10-135) 29,35±24,58(10-135) 22,95±19,4(10-110) 0,031 SD, standard deviation; PSA, prostate specific antigen; AUR, acute urinary retention; LUTS, lower urinary tract symptoms. ⁎ Comparison between the data of AUR and LUTS groups. The patients were compared as to prostatic histopathology. Histopathology of prostatic specimen was not related to the presence of AUR (p=0.115) (Table 2). There was not any difference between the patients with BPH and prostatitis in terms of mean age, PSA level, weight of resected prostatic tissue. Duration of catheterization was longer in patients with prostatitis histopathology than the ones with BPH. Table 2. Relationship between AUR presence and prostate histopathology. Histopathology AUR (+) AUR (-) Total (n) p value BPH 59(36,2%) 104(63,8%) 163 Prostatitis 30(45,4%) 33(54,6%) 63 0,115⁎ AUR, acute urinary retention; BPH, benign prostatic hyperplasia. ⁎ Comparison between the histopathologic results of AUR (+) and AUR (-) groups. CONCLUSIONS In the present study we have determined that higher age, PSA and prostatic size were risk factors for AUR development while prostatic histopathology (being BPH or prostatitis) was not. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e634-e635 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Huseyin Cihan Demirel Ankara, Turkey More articles by this author Cevdet Serkan Gökkaya Ankara, Turkey More articles by this author Cuneyt Ozden Ankara, Turkey More articles by this author Binhan Kagan Aktas Ankara, Turkey More articles by this author Suleyman Bulut Ankara, Turkey More articles by this author Ali Memis Ankara, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The role of ATP-sensitive potassium channel on acute urinary retention and subsequent catheterization in the rat

We investigated the role of K ATP channel on acute urinary retention (AUR) induced bladder dysfunction. Eight-week-old female Sprague–Dawley rats were divided into seven groups: a sham-operated control group, an AUR group, and five AUR groups treated with: two different K ATP channel openers namely nicorandil (3 or 10 mg/kg), or cromakalim (100 or 300 μg/kg), or one K ATP channel inhibitor namely glibenclamide (5 mg/kg). The drugs were administered 30 min before induction of AUR. After the urethra was obstructed with a clip, AUR was induced by intravesical infusion of 2.5 ml of saline via cystostomy. Following a 30 min obstruction the bladder was allowed to drain with a catheter in place for 60 min with real-time monitoring of intravesical pressure and blood flow. After the experimental period, the bladder function was assessed, using organ bath techniques (carbachol and 100 mM KCl). AUR increased the intravesical pressure and decreased the blood flow. The subsequent catheterization decreased the intravesical pressure and increased the blood flow. AUR group reduced significantly the contractile responses to both carbachol and KCl compared with the control group. Nicorandil and cromakalim but not glibenclamide prevented the bladder dysfunction after AUR suggesting that K ATP channel openers may prevent the bladder dysfunction caused by AUR and subsequent catheterization.

Acute urinary retention and subsequent catheterization cause lipid peroxidation and oxidative DNA damage in the bladder: preventive effect of edaravone, a free‐radical scavenger

To investigate the effect of a free-radical scavenger, edaravone, on the changes occurring with acute urinary retention (AUR) and subsequent catheterization in the rat bladder. Eight-week-old male Sprague Dawley rats were allocated to one of four groups; an AUR group that had urinary retention induced, with subsequent catheterization; two edaravone groups, given edaravone at 1 or 10 mg/kg body weight for 60 min and then the same urinary retention and subsequent catheterization; and a sham-operated control group given edaravone 10 mg/kg. Urinary retention was induced by the clamping the rat penile urethra with a small clip, making a cystostomy, and then infusing 3 mL (0.6 mL/min) of saline with an infusion pump. The obstruction was sustained for 30 min and then the bladder was allowed to drain with a catheter in place for 60 min as the studies continued. After killing the rats the function of the bladder was assessed, with carbachol and 100 mM KCl, and the levels of malondialdehyde (MDA, a marker of lipid peroxidation), 8-hydroxydeoxyguanosine (8-OHdG; a marker of oxidative DNA damage), heat-shock protein 70 (HSP 70) and its mRNA were measured. AUR increased the intravesical pressure and decreased blood flow, and subsequent catheterization decreased the intravesical pressure and increased blood flow. Edaravone induced a decrease in blood flow in the bladder during the urinary retention and subsequent catheterization compared to the blood flow in the AUR group. Edaravone resulted in protection of the contractile responses to both carbachol and KCl in a dose-dependent manner. The MDA concentration, 8-OHdG content and expressions of HSP-70 and its mRNA in the AUR group were significantly larger than those of the control group. Edaravone markedly suppressed the accumulations of MDA and 8-OHdG in the bladder, and reduced the expressions of HSP 70 and its mRNA. These results indicate that edaravone reduces the oxidative stress and prevents the bladder dysfunction caused by AUR and subsequent catheterization.

Bladder dysfunction after acute urinary retention in the rats: a novel over active bladder model

As there is increasing evidence that benign prostatic hyperplasia and its related acute urinary retention (AUR) induce over active bladder (OAB) syndrome, we investigated the effects of AUR on bladder function over a 4-week period in a rat model. Ten-week-old female Sprague-Dawley rats were used in this study. AUR was induced by clamping the distal urethra of each rat with a small clip, and then infusing 3 ml (0.6 ml/min) of saline with an infusion pump through a transurethral catheter (22G). The obstruction was sustained for 60 min and the clip was removed and then the bladder was allowed to drain through the catheter. The bladder function was estimated by voiding behavior studies (at 3 days, 1, 2, 3, and 4 weeks), cystometric studies (at 2 and 4 weeks) and organ bath studies using KCl and carbachol (at 2 and 4 weeks). Furthermore, we evaluated histological changes in the rat bladder 2 and 4 weeks after the induction of AUR. The same parameters were also measured in non-AUR rats (control group). The rat bladder weight in the AUR group at 2 weeks was significantly larger than that of the controls, and returned to the control level 4 weeks after the AUR episode. The voiding behavior studies showed significant increase in micturition frequency per day and decrease in single voiding volume 3 days after the induction of AUR, and this voiding behavior was continued for more than 2 weeks. The cystometric studies showed a significant decrease in single-voided volume at 2 weeks rat. However, no significant changes of the other parameters were observed in the rats. The histological studies showed significant infiltration of neutrophils and lymphocytes, as well as increase in turnover of epithelium in AUR rats at 2 weeks, while significant increases in fibrosis in submucosal layer were observed in AUR rats at 4 weeks. This study demonstrated that bladder dysfunction in the rat model caused by AUR needs more than 2 weeks of recovery period. The AUR-associated alterations in the bladder may represent a key clue to understand the underlying pathophysiological mechanisms, which take place in OAB syndrome.

Peak flow rate is the best predictor of acute urinary retention following prostate brachytherapy: Our experience and literature review

We prospectively investigated risk factors for acute urinary retention (AUR) following transperineal radioactive seed implantation for prostate cancer. A total of 273 consecutive patients underwent transperineal ultrasound-guided prostate brachytherapy for clinical T1c-T3b prostate cancer. Preoperative factors included age; International Prostate Symptom score; planimetric prostate and transition volumes (TZV) measured by transrectal ultrasound; peak flow rate; post-void residual urine; neoadjuvant hormone therapy; use of pelvic radiation; and T stage. Intra- and postoperative factors included the number of seeds and needles. Ten patients (3.6%) showed AUR requiring catheterization. Among preoperative factors, age, International Prostate Symptom score, planimetric prostate volume, planimetric prostate volume and radiation therapy (RT) were not significantly correlated with AUR. PFR (P = 0.012) and PVR (P = 0.020) of patients having AUR were significantly higher than those not having AUR. Mean TZV was also significantly higher (P = 0.038) in the AUR group univariate analysis. Multivariate analysis showed that PFR is the only independent predictor of AUR (P = 0.030). On univariate analysis, PFR, PVR and TZV were found to be statistically significant predictors of AUR following seed implantation. According to multivariate analysis, only PFR was confirmed to be a significant predictor.

Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia

Purpose: Acute or chronic prostatic inflammation exists to varying degrees in surgical specimens of prostates, extirpated for the treatment of benign prostatic hyperplasia (BPH). We investigated the relationship between acute urinary retention (AUR) and intraprostatic inflammation. Materials and Methods: Between January 1997 and December 2006, 221 patients underwent transurethral resection of the prostate (TURP) for the treatment of BPH. The patients were divided into 2 groups based on the indication for surgery; an AUR group and a lower urinary tract symptoms (LUTS) group. The area of acute inflammation, the extent, and the aggressiveness of chronic inflammation were classified into four grades. The grades of inflammation, prostate volume, age, serum prostate-specific antigen (PSA), and prior medical treatment were compared between the two groups. All specimens were reviewed by one pathologist. Results: The AUR group consisted of 106 (47.9%) patients, and the LUTS group consisted of 115 (52.1%) patients. There were no statistical differences between the two groups with respect to the mean values of the age, prostate size, and severity of chronic inflammation. There was a significant relationship between AUR and the areas of acute inflammation, and the extent of chronic inflammation (p=0.014 and p=0.003, respectively). The aggressiveness of chronic inflammation had no relationship with AUR (p=0.062). The serum PSA level was higher in the AUR group than the LUTS group (11.5 vs. 5.3ng/ml, respectively). Conclusions: The association for AUR with acute and chronic inflammation was stronger than that which existed with prostate size. Thus intraprostatic inflammation is an important risk factor in AUR. (Korean J Urol 2008;49:1081-1086) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏