High Pressure Chronic Retention Research Articles

Urinoma: Saviour of beleaguered kidney

Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study revealed preserved left renal function; however the right hydroureteronephrotic kidney shrank in size. Conclusion: Spontaneous perinephric urinoma formation due to High pressure chronic retention was a blessing in disguise for the patient. It saved the affected kidney from getting knocked out. The other side hydroureternephrotic kidney suffered anatomical and functional loss.

Clinical characteristics and outcome of high-pressure chronic urinary retention: A systematic review

Background: Although not infrequent, publications on high-pressure chronic urinary retention (HPCR) are limited. Lack of awareness of this condition can lead to delayed diagnosis and suboptimal treatment. This systematic review aimed to describe the clinical characteristics and outcome of HPCR. Methods: Keywords were searched in PubMed, Scopus, EMBASE, LILACS, Cochrane-CENTRAL, APAMED Central and Google Scholar. Relevant articles were added from the list of references of eligible articles. Studies describing any two of the characteristic features related to HPCR were included. Qualitative analysis was performed using the available data. Results: Eight prospective studies with 271 patients ( Mage=66.4 years, range 14–89 years; 263 males) were identified. The commonest presentation was tense painless palpable bladder (99.6%). Late-onset nocturnal enuresis was reported in 68.4%, and resistant hypertension was reported in 41.6%. Elevated levels of serum creatinine were identified in 43–81%. Benign prostatic hyperplasia (64.1%) was the commonest aetiology followed by prostatic malignancy (22.6%). A satisfactory response was seen following the definitive treatment of the underlying aetiology. Initial bladder decompression reversed adverse cardiovascular changes and improved renal function but resulted in post-obstructive diuresis. Heterogeneity of the reported data in available studies was a major limitation. Conclusions: Late-onset nocturnal enuresis, a tense painless and non-tender palpable bladder and treatment-resistant hypertension are important clinical findings which would raise the suspicion of HPCR in the clinical setting. Urinary tract ultrasonography showing upper-tract dilatation and raised serum creatinine support the diagnosis. Definitive treatment targeting the underlying aetiology following careful decompression of the bladder showed satisfactory outcomes. Level of evidence: Level 2a(-).

Unilateral Lower Limb Oedema: An Unusual Presentation of High-Pressure Chronic Retention

High-pressure chronic retention (HPCR) is a well-recognized common urological emergency which requires prompt treatment. It usually presents with nocturnal enuresis, a tense and palpable bladder, and symptoms of uraemia from renal failure George et al 1983.1 There have been isolated cases in the literature of HPCR presenting with symptoms of venous occlusion secondary to extrinsic bladder compression2,3 but it remains a rare presenting complaint. We discuss the case of a 56-year-old man who presented primarily with right lower limb swelling which was later revealed to be due to HPCR.

Post-prostatectomy Lymphocoele Presenting With Renal Failure

Since its advent in 2001, robotic-assisted laparoscopic prostatectomy has become the gold standard treatment for the management of localized prostate cancer.Pelvic lymphocoele is most commonly found after gynecological or renal transplant surgery or following extensive pelvic lymphadenectomy. Its formation following prostatectomy is not uncommon1 but it seldom causes major complications or morbidity.2We present a case of a 66-year-old man who presented with left-sided abdominal pain, a palpable infra-umbilical mass, and renal failure. He was initially presumed to have high pressure chronic retention however catheterization did not result in any improvement in his renal function. Further investigations revealed a large lymphocoele causing bilateral ureteric obstruction with resultant hydronephrosis.

Generation of a urachal cyst and abscess secondary to high pressure chronic urinary retention

Generation of a urachal cyst and abscess secondary to high pressure chronic urinary retention

Management of the complications of BPH/BOO.

Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.

Nocturnal Enuresis in Adults

Nocturnal enuresis in adults is a clinical entity which has not been studied extensively. Hence data available is limited. Though less common than childhood nocturnal enuresis, it can be distressing and may denote a significant underlying pathology. It can be divided into three subgroups - persistent primary nocturnal enuresis, recurrent nocturnal enuresis and recent onset nocturnal enuresis. Persistent primary and recurrent nocturnal enuresis are commonly due to nocturnal polyuria and nocturnal detrusor overactivity. These can be treated by desmopressin with or without anticholinergic drugs. Recent onset nocturnal enuresis in adults is associated with high pressure chronic urinary retention which could cause renal impairment and even death. Therefore such patients should be evaluated to identify the underlying cause of their bladder outflow obstruction. Most of them require corrective surgery to relieve the obstruction.

Significant upper urinary tract hematuria as a rare complication of high-pressure chronic retention of urine following decompression: a case report

IntroductionHematuria has been described following bladder drainage in 2% to 16% of high-pressure chronic urinary retention treatments by decompression and is generally self-limiting. We describe a case of significant bilateral upper urinary tract hematuria following drainage of high-pressure chronic retention. To the best of our knowledge, the only similar case reported in the literature was in 1944.Case presentationAn 82-year-old Caucasian man was referred to our department with nocturnal enuresis and a palpable bladder. He was catheterized, produced a residual volume of 2900mL, and ended up becoming oliguric. Following investigations, he had bilateral nephrostomies. He was discharged 18 days after presentation.ConclusionsClinicians should keep in mind the presentation discussed in this case report to be able to swiftly manage this extremely rare complication of decompression in patients with high-pressure chronic retention.

Adult Care of Children From Pediatric Urology

In this article we highlight the difference, from established adult urology, in required approach to the care of adolescents and young adults presenting with the long-term consequences of the major congenital anomalies of the genitourinary tract. We review some abnormalities of the kidneys, progressive renal failure and disorders of bladder function from which general conclusions can be drawn. The published literature was reviewed and augmented with material from our institutional databases. For renal function the CAKUT (congenital abnormalities of the kidney and urinary tract) database at University College London Hospitals was used, which includes 101 young adult patients with CAKUT in whom the urinary tract has not been diverted or augmented. For bladder function some data are from patient records at Boston Children's Hospital. Adolescents who grow up with the burden of a major congenital anomaly have an overwhelming desire to be normal. Many achieve high levels of education and occupy a wide range of employment scenarios. Babies born with damaged kidneys will usually experience improvement in renal function in the first 3 years of life. Approximately 50% of these cases will remain stable until puberty, after which half of them will experience deterioration. Any urologist who treats such patients needs to test for proteinuria as this is a significant indicator of such deterioration. In its absence, the urologist must have a reasonable strategy for seeking a urological cause. The most effective management for nephrological renal deterioration is with angiotensin converting enzyme inhibitors, which slow but do not prevent end stage renal failure. Renal deterioration is generally slower in these patients than in those with other forms of progressive renal disease. The bladder is damaged by obstruction or by functional abnormalities such as myelomeningocele. Every effort should be made to stabilize or reconstruct the bladder in childhood. A dysfunctional bladder is associated with or causes renal damage in utero, but continued dysfunction will cause further renal damage. Bladder function often changes in puberty, especially in boys with posterior urethral valves who may experience high pressure chronic retention. Dysfunction is managed with antimuscarinic drugs, clean intermittent self-catheterization and intestinal augmentation. Adult urologists must be able to manage the long-term problems associated with these treatments. Pediatric conditions requiring management in adolescence are rare but have major, lifelong implications. Their management requires a broad knowledge of pediatric and adult urology, and could well be a specialty in its own right. Therefore, adult urologists must remain aware of the conditions, the problems that they may encounter and the special management required for these patients to live normal lives.

High pressure chronic retention: a life-threatening clinical entity

To report our experience with high pressure chronic retention (HPCR), a clinical syndrome with potentially disastrous consequences. A prospective hospital based descriptive study. Setting A urology unit at the National Hospital of Sri Lanka, Colombo. Patients Forty seven consecutive new patients with HPCR evaluated during a 2-year period. Of the 47 (39 male) patients, 15 (32%) were below 50 years of age. Nocturnal enuresis was encountered in 32 (68%) patients, and a tense, non-tender distended bladder found in all 47 patients. Hypertension was recorded in 25.5% of the patients. Bilateral hydroureteronephrosis was detected on ultrasonography in nearly 80% of the patients, and renal impairment was found in 20 (42.5%). The mean retained volume was 968 mL. Seven (15%) patients developed post-obstructive diuresis. Eight women (mean age 47.5 years, range 30-70 years) had HPCR. Four had no obvious cause. Six (75%) had adult onset nocturnal enuresis. Renal impairment was found in four (50%) patients. Post-obstructive diuresis was recorded in two women. HPCR, a clinical entity known to affect the elderly in the West, was found to affect a relatively young patient group in Sri Lanka. The symptom of adult-onset nocturnal enuresis should alert the clinician to the possibility of HPCR. Renal failure is common at initial presentation. Urethral catheterization could lead to life-endangering diuresis. We describe eight women with this entity, hitherto unreported in the medical literature.

Identification of patients requiring out-patient follow-up after transurethral prostatectomy: is there a role for nurse-led screening of post-operative outcomes by telephone?

To determine the most efficient method to follow patients after transurethral prostatectomy (TURP) such that only those patients suffering significant post-operative problems are reviewed. The study comprised two parts: (1) a retrospective review of the case notes of 100 consecutive patients who underwent TURP under one consultant to determine whether any factors could be identified pre- or post-operatively by which those patients most likely to require clinic review could be selected and; (2) a prospective review of the succeeding 100 patients undergoing TURP, using a telephone 'screening' call made by the urological research nurse 3 months after the operation. Patients who requested follow-up and those patients with malignancy or admitted in high-pressure chronic retention were reviewed in the out-patient department. In the first part, 17 patients (17%) required an out-patient review for malignancy. Only nine patients (11%) with benign histology required further treatment after TURP; this subgroup could not be identified on the basis of their pre- or post-operative symptoms. In the second part, 23 patients were not reviewed by telephone; 14 had carcinoma of the prostate, eight had no telephone and one could not be contacted after seven attempts. Of the remaining 77 contacted by phone, 61 (79%) declined further clinic review and 16 (21%) requested follow-up for persistent problems. A mean of two calls was made per patient and the mean duration of each call was 6.3 min. Based on pre- or post-operative symptoms at the time of discharge, there is no reliable method of identifying those patients who have a poor result after TURP. Telephone screening of patients at 3 months identified successfully those patients who required an out-patient review and enabled resources to be targeted towards this difficult group of patients.

Disturbance in Sodium Regulating Hormones in Chronic Obstructive Uropathy

Serum atrial natriuretic peptide (ANP), plasma renin activity (PRA), angiotensin II (AII) and aldosterone levels have been studied in patients with chronic bilateral ureteric obstruction resulting from high pressure chronic retention of urine (HPCR), both in the obstructed state and during the post-obstructed period. Increased ANP levels observed during chronic obstruction fell rapidly following urinary tract decompression by urethral catheterisation. Serum ANP resurged briefly within 24 h but stabilised thereafter at a lower level. PRA was initially suppressed but rose after catheterisation, the increase lagging behind the changes seen for ANP. Rising levels of AII and aldosterone followed this trend but, unlike PRA, levels were not completely suppressed in the obstructed state. The observed hormonal changes probably reflect homeostatic mechanisms directed to the maintenance of sodium and water balance during obstruction and to limitation of the diuresis following its relief.

Relationship between Bladder Morphology and Long-term Outcome of Treatment in Patients with High Pressure Chronic Retention of Urine

A group of 32 men undergoing bladder outflow surgery for high pressure chronic retention (HPCR) of urine were studied prospectively. At the time of treatment marked morphological changes in the bladder wall were demonstrated histologically, but after a mean follow-up of 42.9 months residual urine had decreased significantly and renal function had improved or stabilised in 28 patients (84%). Four patients deteriorated but in 3 of these another potential cause for loss of renal function was present. The majority of patients have a good long-term prognosis following treatment for HPCR.

Assessment of the nephron segments involved in post-obstructive diuresis in man, using lithium clearance.

The phenomena of post-obstructive diuresis and natriuresis have been studied using the lithium clearance technique in 10 patients with high pressure chronic retention. Following relief of obstruction there was a significant increase in both sodium and water excretion. There was a coincident reduction in the fractions of sodium and water reabsorbed in both proximal and distal nephron segments. This study demonstrates for the first time that following relief of chronic obstructive uropathy in man, changes in sodium and water excretion are due to altered handling in both proximal and distal nephron segments.

Unrecognised high pressure chronic retention of urine presenting with systemic arterial hypertension.

A propos de 6 cas: hommes âgees de 50 a 70 ans, hospitalises pour hypertension arterielle. Les examens revelent une retention urinaire a une hypertrophie prostatique. Apres operation transuretrale, la retention d'urine et l'hypertension regressent; la creatinineurie d'urine, le debit plasmatique renal et la filtration glomenulaire augmentent

The biphasic nature of renal functional recovery following relief of chronic obstructive uropathy.

Twenty-one patients with chronic obstructive uropathy due to high pressure chronic retention of urine underwent renal functional assessment both during the period of obstruction and repeatedly up to 3 months following its relief. Glomerular filtration rate (GFR) was determined using clearance of 99mTc-DTPA and iohexol. Creatinine, water, urea and electrolyte excretion was assessed from timed urine collections. Excretion of water, urea and electrolyte was normal during obstruction but increased dramatically immediately following relief (e.g. sodium 110 to 234 mmol/24 h). Values returned to normal by 2 weeks (sodium excretion 148 mmol/24 h). No further significant changes occurred up to 3 months. Mean 99mTc-DTPA and iohexol clearances during obstruction were 59.0 and 50.5 ml/min respectively. Following relief of obstruction, no significant improvement occurred at 2 weeks but did at 3 months (mean = 68.4 and 55.7 ml/min). Mean creatinine clearance during obstruction was 32.5 ml/min. This improved 2 days following relief to 46 ml/min. No further improvement was seen until 3 months (mean = 57.3 ml/min). It was concluded that recovery of renal function from obstructive injury occurs in two phases, an early tubular phase lasting up to 2 weeks and a later, predominantly glomerular phase, between 2 weeks and 3 months. There is some disparity between creatinine clearance and more accurate measurements of GFR which may be explained by tubular excretion of creatinine in the early phase of recovery.

Reversible Hypertension Associated With Unrecognised High Pressure Chronic Retention of Urine

Reversible Hypertension Associated With Unrecognised High Pressure Chronic Retention of Urine

High pressure chronic retention. Incidence, aetiology and sinister implications.

A prospective analysis of 36 consecutive cases of high pressure chronic retention presenting over a 3-year period is described. Thirty-nine per cent of patients had malignant prostates and 14% had bladder tumours (overall malignancy rate 53%). The dangers of mismanagement of high pressure chronic retention include uraemic death and hypovolaemic circulatory collapse from neglected post-obstructive diuresis. The clinician should be prepared to find a high incidence of urological malignant disease in patients presenting with this syndrome.

Chronic retention of urine. The relationship between upper tract dilatation and bladder pressure.

Twenty-five men with chronic retention of urine were studied in order to investigate the relationship between upper tract dilatation and bladder pressure. Each underwent assessment of upper tract dilatation and urodynamic investigation before bladder drainage. Patients were reassessed 3 or more months after operation. Residual urine and detrusor contraction pressure decreased significantly after operation (P less than 0.0001:P less than 0.01). A significant increase in effective cystometric capacity and a significant decrease in pressure rise during filling led to an improvement in compliance. At pre-operative assessment, patients with upper tract dilatation had a significantly greater resting bladder pressure (P less than 0.05), end filling pressure (P less than 0.002) and pressure rise during filling (P less than 0.02) than those without upper tract dilatation. In addition, statistically significant correlations were found between serum creatinine and end filling pressure (P less than 0.05) and between upper tract dilatation and both high end filling pressure (greater than 25 cm H2O) and high pressure rise during filling (greater than 15 cm H2O: both P less than 0.05). Whilst high end filling pressure and high pressure rise during filling were found to be closely associated with upper tract dilatation (sensitivity 93 and 100%), there was a high false positive rate (specificity 64 and 45%). Furthermore, statistical analysis demonstrated that these data had a continuous though skewed distribution, suggesting that it is not possible to make a clear distinction between high and low pressure chronic retention.

Renal pelvic pressures in human chronic obstructive uropathy.

Resting renal pelvic pressure and premicturition bladder pressure have been measured by direct percutaneous puncture in 12 male patients with established chronic obstructive uropathy related to high pressure chronic retention. In 10 technically satisfactory cases the subtracted renal pelvic pressure was less than the intrinsic bladder pressure, showing that upper tract dilatation and diminished renal function in these patients were not due to direct extension of high resting bladder pressure into the upper tract. The mean resting upper tract pressure in chronic human obstructive uropathy was 10.7 cm of water.