Acute Urinary Retention In Patients Research Articles

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.

Benign prostatic hyperplasia morphological parameters for assessing risk of acute urinary retention

Aim of the studyTo evaluate objective measurements of morphological changes of the prostate in Benign Prostatic Hyperplasia (BPH) as predictors of acute urinary retention (AUR).MethodsOverall 169 consecutive patients older than 50 years of age were prospectively divided into group A (n = 61); men with acute urinary retention (AUR), or group B (n = 108); men with different degrees of lower urinary tract symptoms (LUTS). Transrectal ultrasound (TRUS) measurements of total prostate volume (TPV), transitional zone volume (TZV), ratio of TZV to TPV (TZV/TPV), and vesico-urethral angle (VUA) were recorded. Group B patients also had post-void residual (PVR) and maximum flow rate (Q-max) recorded. TZV/TPV and VUA were correlated with Q-max and PVR, and a comparison was made between the two groups.ResultsGroup A had significantly larger TPV (p = 0.03) and TZV/TPV (p = 0.04) compared to Group B. VUA in Group A had a significant correlation with AUR (p = 0.02). In Group B, both TZV/TPV and VUA had significant correlation with PVR and Q-max. A TZV/TPV cutoff ratio of 0.67 as a predictor of AUR had a 68% overall accuracy with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88%, 53%, 44%, and 97%, respectively. VUA of < 90º as a predictor factor of AUR had a 67% overall accuracy with sensitivity, specificity, PPV and NPV of 88%, 50%, 44%, and 97%, respectively.ConclusionMorphological changes in BPH can be objectively quantified using ultrasound by TZV/TPV and VUA. These parameters may potentially serve as predictors of AUR in patients with BPH.

Features of the Course of Lower Urinary Tract Symptoms in Men with Benign Prostate Hyperplasia and COVID-19

Nowadays men’s health remains in priority. It is given no less attention than to the cardiovascular disorders and cancer. Low urinary tract symptoms (LUTS) accompany most urological diseases and thus are among the most significant syndromes in urology. The medico-social significance of the syndrome puts the development of protocols for its effective detection and drug treatment with long-term efficacy in a number of priority tasks, stimulating the pharmaceutical industry to search for promising candidates.. Restrictions of COVID-19 Pandemic prevent routine procedures by urologists, prompting them to provide online counseling. Under these circumstances, recommendations were made on the strategy and tactics of treatment of urological diseases during a pandemic, as well as strategic directions in the urology of the future were identified. There is a worldwide consensus among experts on minimizing invasive treatments for benign prostatic hyperplasia (BPH) to maximize the protection of medical personnel from the potential risk of COVID-19 infection, while direct contact with patients is not always possible to avoid. It is known from scientific sources that, in contrast to 2019, in 2020 there was a tendency of increase the share of hospitalizations for emergency urological conditions as well as the share of critical conditions, requiring the strengthening of anti-epidemic measures. Over the past year the ability of the SARS-CoV-2 virus to increase the severity of LUTS in men with urological pathology was reported. Furthermore the development of severe urogenital symptoms (COVID-19-associated cystitis) with a high content of proinflammatory cytokines not only in blood plasma but also in urine was registered. This allows to include LUTS «de novo» in the complex of symptoms of COVID-19. Physicians should be aware of urogenital manifestations COVID-19 and include verification of bladder dysfunction to diagnostic program. Strict adherence to WHO and EAU anti-epidemic recommendations and algorithms is extremely important, so we provide online counseling to patients with symptomatic BPH, ensuring the continuity of the specialized treatment process and minimizing direct contact. The proposed method of treatment of moderate to severe BPH associated LUTS involves tamsulosin monotherapy or in combination with finasteride. The results of the use of tamsulosin hydrochloride in cases of LUTS in BPH indicate that the percentage of acute urinary retention in patients receiving monotherapy is almost similar to that when using combination therapy (tamsulosin + finasteride) and is about 7.0% per year. The obtained data suggest that the observation of patients at a distance can be justified only temporarily, but requires strict adherence to an individually designed treatment plan, which should be based on the guidelines of the Ministry of Health of Ukraine and WHO standards. The problem of BPH is a very important issue in modern medicine and requires clear treatment algorithms, with different contexts of modern realities, such as the latest data on certain links in the pathogenesis of urinary tract obstruction caused by BPH on the background of COVID-19.

Post-Operative Acute Urinary Retention After Greenlight Laser. Analysis of Risk Factors from A Multicentric Database.

Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.

A Study of Etiology, Clinical Profile and Outcome of Patients Presenting with Acute Urinary Retention to a Tertiary Care Hospital

Introduction: Acute urinary retention (AUR) is defined as the sudden inability to pass urine even with a distended bladder. A population-based study reported the incidence AUR of 2.2 to 6.8 per 1000 men per year. One in 10 men over the age of 70 may experience AUR within 5 years. In contrast, AUR is rare in women. Definitive management of AUR depends on the precipitating cause which can be medical or surgical. Immediate treatment of AUR is to drain the urinary bladder either by urethral catheterization or by a suprapubic cystostomy. Prospective studies on AUR are few in India, and very less is known regarding its prevalence. In view of this, there is a need to formulate a baseline data in the area of acute urinary retention. Aims and Objectives: 1. To study etiology of Acute Urinary Retention in patients presenting at Tertiary Care Hospital. 2. To study the clinical profile of patients presenting with Acute Urinary Retention to a Tertiary Care Hospital. Material and Methods: It is a Prospective Observational Study conducted on patients visiting the Emergency department, OPD and/or cases admitted in the IPD for Acute Urinary Retention in the department of General Surgery at Tertiary Care Hospital. Relevant history was taken and detailed clinical examination along with appropriate investigation including ultrasonography, etc. were carried out in all cases. Appropriate medical (including medication, urethral catherization or suprapubic catherization) or surgical treatment (like surgeries for urethral stricture, phimosis, urethral calculus etc.) was given to the patient as per standard hospital protocols. Results: Mean Age of the study group was 61.54 years with majority of the patients 68% were more than 60 years of age. Male preponderance was observed in the study group with prevalence ratio of 48 (96%) males to only 2 (4%) females. Most common etiology of acute urinary retention was benign prostate hyperplasia (44%) followed by urethral stricture (26%), carcinoma prostate (6%), phimosis (6%) and bladder neck calculi (4%). Foley's catheterization was done in 41 cases (82%) while supra-pubic catheterization was done in 9 cases (18%) cases. Out of the 36 cases in which trial without catheterization was attempted, 32 were successful. Out of the 45 cases with surgical management, TURP was done in 22 cases while Urethrotomy and Cystolithotrypsy was done in 12 and 4 cases. TURP + bilateral orchidectomy and circumcision was done in 3 and 2 cases respectively. Conclusion: The most common age for presentation with Acute Urinary Retention is 51-70 years and with male predominance. In our study we can conclude that the most common etiology for AUR is Benign Prostatic Hyperplasia followed by Urethral Stricture, Carcinoma of Prostate and Phimosis. The primary management to relieve the retention in an emergency situation is mainly by urethral catheterization failing which Suprapubic catheterization is done but definitive management for AUR is surgical.

Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy?

Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.

The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study

Introduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant.

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.

Possibility of the analysis of an outcome of conservative treatment of the acute urinary retention in patients with benign prostatic hyperplasia

Actuality. The article studies the possibility of the conservative treatment of acute urinary retention in patients with benign prostatic hyperplasia.&#x0D; The purpose of this study is to improve the results of treatment of patients with acute urinary retention by revealing a complex of factors influencing the prognosis and treatment modalities.&#x0D; Materials and methods. Assessment of the prediction of the response to the treatment was performed by means of the study of 280 patients hospitalized in the urology department No. 8 within 20122015. A retrospective analysis of the treatment outcomes has been performed.&#x0D; Results and conclusions. Correlation and regression analysis reveals a complex of the most significant independent factors that influence the outcome of conservative treatment of acute urinary retention in case of benign prostatic hyperplasia. These factors can be used as the basis for a mathematical model for predicting the outcome of conservative treatment of acute urinary retention during BPH. A computer program to estimate the prognosis of life of patients has been developed. This program allows to develop the best treatment modality for a particular patient.

Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer: A population-based retrospective cohort study.

Acute urinary retention (AUR) is associated with hormone imbalance in men. However, limited studies focused on exploring the complications of AUR in patients with prostate cancer (PC) who receive androgen deprivation therapy (ADT). Therefore, we aim to evaluate the subsequent risk of AUR in ADT-treated PC patients. We collected data from 24,464 male patients who were newly diagnosed with prostate malignancy from a longitudinal health insurance database of catastrophic illness in 2000 to 2008. All PC patients were categorized into 2 cohorts, namely, ADT cohort and non-ADT cohort, based on whether or not the patient receives ADT. The patients were followed up until the occurrence of AUR. Multivariate Cox proportional hazard regression and Kaplan–Meier analysis were performed. After a 12-year follow-up, the incidence rates of AUR were 12.49 and 9.86 per 1000 person-years in ADT and non-ADT cohorts, respectively. Compared with the non-ADT cohort, the ADT cohort had a 1.21-fold increase in AUR risk based on the adjusted model (95% CI = 1.03–1.43). In addition, PC patients receiving early ADT treatment within 6 months or receiving only luteinizing hormone-releasing hormone treatment also had significantly increased risk of AUR. ADT was positively associated with AUR risk. PC patients receiving ADT should be informed about the risks of bladder outlet obstruction and AUR, and they may benefit from screening for related risk factors. New guidelines and treatments should be proposed in the future to manage ADT-related lower urinary tract symptoms and reduce the risk of AUR.

Selective Alpha Adrenoblocker and the Risk of Development of Acute Urine Retention

The article analyzes the modern scientific works on the effectiveness of conservative therapy for benign prostatic hyperplasia and acute urinary retention of various etiologies with tamsulosin. The use of tamsulosin in patients with benign prostatic hyperplasia has a positive effect on reducing the overall level of complications such as acute urinary retention. According to modern meta-analyzes on this problem, tamsulosin is one of the main drugs that are effectively used to reduce the risk of acute urinary retention in patients with benign prostatic hyperplasia and patients at risk of developing acute postoperative urinary retention.

A study on acute urinary retention in patients with benign prostatic hyperplasia at a rural setup

Background: Acute urinary retention (AUR) is one of the most significant complications of benign prostatic hyperplasia (BPH). Aim was to discuss the management of AUR in BPH in a rural setup.Methods: It was a prospective study, at PESIMSR, Kuppam, on 100 BPH patients who presented to the ER or OPD with AUR from November 2016 to June 2018. All were catheterized initially. Patient clinical characteristics, prostate size, type of AUR and management one (type of catheterization, hospitalization, trial without catheterisation (TWOC), use of medication, immediate and elective surgery) were recorded.Results: Mean age was 68.33±9.1. Most patients (74 %) had spontaneous AUR and rest had precipitating factors. A per-urethral catheter (PUC) was inserted in most cases (96%), rest had supra-pubic cystostomy (SPC). Patients with prostate volume of &lt;30 ml (n=8) were started on alpha-blocker (AB) alone and those with &gt;30 ml were given AB with 5 alpha-reductase inhibitor (ARI) combination. TWOC had an overall success rate of 72% (n=72), of them 38 opted for elective surgery. TWOC failed in 28 patients who were re-catheterized and underwent transurethral resection of prostate (TURP) on an elective basis. 66 out of 100 patients underwent TURP in the course of management of AUR in BPH.Conclusions: Management of AUR in BPH patients in real-life practice in a rural setup hospital has been evaluated. It shows that urethral catheterization, medication, TWOC and finally continuing medical management or planning TURP based has become standard practice.

PT167 - Detrusor wall thickness does not predict a successful trial without catheter after acute urinary retention in patients on medical treatment for benign prostatic hyperplasia

PT167 - Detrusor wall thickness does not predict a successful trial without catheter after acute urinary retention in patients on medical treatment for benign prostatic hyperplasia

P127 - Detrusor wall thickness does not predict a successful trial without catheter after acute urinary retention in patients on medical treatment for benign prostatic hyperplasia

P127 - Detrusor wall thickness does not predict a successful trial without catheter after acute urinary retention in patients on medical treatment for benign prostatic hyperplasia

Comparison of the delta neutrophil index with procalcitonin, erythrocyte sedimentation rate, and C-reactive protein as predictors of sepsis in patients with acute prostatitis.

BackgroundWe investigated the usefulness of inflammatory markers including the delta neutrophil index (DNI), erythrocyte sedimentation rate, C-reactive protein, and procalcitonin as early predictors of sepsis in patients with acute prostatitis (AP). In addition, we evaluated the efficacy of intermittent catheterization for the initial management of acute urinary retention (AUR) in patients with AP.Materials and methodsAll patients who presented to the emergency department and were admitted to the urology department from January 2011 to December 2013 were retrospectively reviewed. The clinical features, prostate-specific antigen levels, inflammatory marker levels, and urine and blood culture results were obtained from medical records. Patients who underwent urethrocystoscopy or prostate biopsy within 7 days were excluded.ResultsOf 132 patients (mean age, 64.8 years) in this cohort, 17 (12.9%) had sepsis and 22 (16.7%) had positive blood cultures. Escherichia coli was the most common isolate in blood and urine cultures. In multivariate analysis, the DNI and prostate-specific antigen were identified as predictors of sepsis. The DNI was a significant prognostic factor for bacteremia. In patients with AP, procalcitonin was not a significant predictor of sepsis. Of 19 patients with AUR, 10 needed Foley catheterization because of refractory AUR. C-reactive protein was a significant predictor of failure of the initial management of AUR.ConclusionsThe DNI is useful as a predictive factor for sepsis and bacteremia in patients with AP. Without mandatory cystostomy, intermittent catheterization could be one of the useful management options of AUR in patients with AP.

Effectiveness of the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia: A randomized clinical trial.

Acute urinary retention is one of the most significant complications of benign prostatic hyperplasia. Until now, standard treatments include catheterization and use of α-blockers. Tadalafil has been recently seen to also play a role in the treatment of urinary symptoms caused by benign prostatic hyperplasia. The aim of this study was to survey the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. This is a randomized, double-blind placebo-controlled clinical trial. In all, 80 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department of the hospital were divided into two groups of 40 each and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus 10 mg tadalafil daily for 7 days. At the same first visit, the catheter was removed and the ability to void in 24 h and 1 week later was assessed in each group. The differences in age, urine retention volume, history of drug use, lower urinary tract symptoms, and previous acute urinary retention were not significant between the two groups ( p = 0.619, 0.149, 0.501, 0.284, and 0.371, respectively). After catheter removal, 23 (57.5%) patients in the placebo group and 26 (65%) in the tadalafil group voided successfully at 24 h ( p = 0.491). After 1 week, 29 (72.5%) patients taking placebo and 26 (65%) taking tadalafil could void, yet indicating no significant difference ( p = 0.469). Addition of tadalafil to α-blockers has no significant advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone.

Рrevention and treatment of acute urinary retention in patients with benign prostatic hyperplasia

Рrevention and treatment of acute urinary retention in patients with benign prostatic hyperplasia

The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery.

ABSTRACTIntroduction:The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood.Objectives:To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery.Subjects and Methods:We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis.Results:There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012).Conclusions:The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Terazosin versus Alfuzosin in Treatment of Acute Urinary Retention in Patients with Benign Prostatic Hypertroph

Objective To compare the efficacy and adverse reactions of terazosin and alfuzosin in treatment of acute urinary retention in patients with benign prostatic hypertrophy. Design Case control study. Setting Emergency department of a regional hospital in Hong Kong. Methods Our study included all adult male with age at least 18 years old presented with acute urinary retention, having residual urine volume greater than or equal to 300 ml after urinary catheterisation and with a presumed diagnosis of benign prostatic hypertrophy. Patients treated with terazosin from December 2013 to February 2014 were retrospectively included while patients treated with alfuzosin from April to September 2014 were prospectively included. We compared the two groups on: trial without catheter (TWOC) rate, potential adverse effects including drug-associated postural hypotension, haemodynamic changes and prolongation of corrected QT interval in electrocardiogram. Cost effectiveness analysis was performed. Results A total of 116 patients were included with 59 and 57 patients in the terazosin and alfuzosin group respectively. Logistic regression showed that residual urine volume (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996-0.999, p=0.008) and presence of precipitating factors (OR=2.264, 95% CI=1.045-5.793, p=0.045) were independent predictors of successful TWOC. There was no significant difference in the TWOC rate for patients treated with alfuzosin and terazosin. There was significantly more symptomatic postural hypotension in the terazosin group compared with the alfuzosin group. The number need to treat with alfuzosin for terazosin to avoid one adverse drug effect was 12.3 patients (95% CI=4.7-21.6) and 9.9 patients (95% CI=5.3-84.6) to reduce one postural hypotension and symptomatic postural hypotension respectively. Conclusions Alfuzosin is comparable to terazosin in TWOC rate. However, alfuzosin is associated with a lower rate of symptomatic postural hypotension and less haemodynamic impact than terazosin. (Hong Kong j.emerg.med. 2015;22:210-218)

Predicting Acute Urinary Retention in Patients with Elevated Post-Void Residuals

Objectives: To perform a retrospective analysis evaluating factors that may predict which men with elevated post-void residuals (PVRs) that were at increased risk to develop acute urinary retention (AUR). Methods: We retrospectively analyzed the records of 44 male patients who had 2 consecutive PVRs greater than 100 ml over a 6-month period. Using regression analysis, we evaluated patient's age, PVR volume, prostate specific antigen (PSA) and transrectal ultrasound prostate volume with respect to development of AUR over 24 months. Results: Of the 44 patients, 4 developed AUR. When all factors were considered, prostate volume was determined to be the only that was statistically significant (p = 0.003). A 1-SD increase in prostate volume (12 ml) led to a 19.6% increased risk of developing AUR. There was a strong correlation between PSA and prostate volume (0.787). A regression analysis was then repeated excluding prostate volume. PSA then became a statistically significant predictor of AUR (p = 0.007). A 1-SD increase in PSA (1.377 ng/ml) increased the patients' risk of developing AUR by 12.3%. Conclusion: In men with an elevated PVR, increased transrectal ultrasound prostate volume or PSA may help predict which patients have an elevated risk of developing AUR within the next 24 months. This information may influence which patients need early surgical intervention versus medical therapy.