Occurrence Of Urinary Retention Research Articles

Medical Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

Abstract Context Medical treatment is the primary option for most patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; LUTS/BPH), but individual patients may have distinct treatment goals. Objective To describe the specific effects of available treatment options on symptom relief as well as on disease progression in relation to their potential side-effects. Evidence acquisition PubMed was screened for studies, meta-analyses, and reviews describing medical treatments of LUTS/BPH. Evidence synthesis The two main options for medical treatment are α 1 -adrenoceptor antagonists (ARBs) and 5α-reductase inhibitors (ARIs). ARBs cause fast and persistent symptom relief but do not reduce prostate size or prevent progression as assessed (eg, by occurrence of urinary retention). All ARBs are similarly effective; alfuzosin and tamsulosin have the best tolerability. ARIs reduce prostate size and prevent disease progression, but symptom reduction occurs more slowly and is less pronounced than with ARBs. Dutasteride and finasteride appear to be similarly effective and tolerated. Due to differential modes of action, the combination of ARBs and ARIs has additive effects against combined end points of disease progression, but they also have additive side-effects. While several other treatment options are currently under investigation, none are sufficiently well documented to allow treatment recommendations. Conclusions We propose that ARBs and ARIs have distinct clinical effects and, hence, should be considered for distinct groups of LUTS/BPH patients based on specific treatment goals in a given patient.

Progression delay in men with mild symptoms of bladder outlet obstruction: a comparative study of phytotherapy and watchful waiting

To determine the effect of phytotherapy (Serona repens) on the clinical progression in men with mild symptoms of bladder outlet obstruction (BOO). A total of 189 patients with mild symptoms of BOO, recruited from four different European clinics, were included in the analysis. Age, prostate specific antigen (PSA), international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax) and total prostate and transitional zone volume were recorded. Clinical progression was defined as change from the mild-IPSS group into the moderate or severe group or the occurrence of urinary retention and need of surgery. Cumulative progression rate was 1, 7, 9 and 16% at 6, 12, 18 and 24 month, respectively, for the active group (Serona repens) as compared to 6, 13, 15 and 24% for the watchful waiting group. (P=0.03) significant improvements in the Qmax, IPSS and QOL were seen in the group receiving Serona repens. Serona repens significantly reduced the clinical progression rates in men with mild symptoms of BOO. It also led to improvements in urinary symptoms, QOL scores and urinary flow rates.

Acute urinary retention associated with fractured osteophyte

A 24-year-old man presented to our hospital twice with acute urinary retention in March 2002. Myelographic computed tomography demonstrated a posterior osteophyte. The preoperative urodynamic study indicated detrusor overactivity and detrusor sphincter dyssynergia 30 days after the first occurrence of urinary retention. During osteophyte resection and laminoplasty, the osteophyte, which was found to be fractured and to press on the cauda equina, was removed. The postoperative urodynamic study showed that detrusor overactivity remained and detrusor sphincter dyssynergia had disappeared. The patient was regularly followed up as an outpatient, and no dysuria had been noted by January 2003.

Caudal epidural morphine for control of pain following open heart surgery in children

The safety and efficacy of epidural morphine injected into the caudal space for control of postoperative pain following open cardiac surgery in children was studied. Thirty-two children between the ages of 2-12 yr for whom early postoperative tracheal extubation was anticipated were randomly assigned to control and study groups. Study subjects received a caudal injection of preservative free morphine sulfate (0.075 mg/kg) in preservative-free normal saline (5-10 ml) following completion of surgery, but prior to awakening and extubation of the trachea. Supplemental intravenous morphine administration and pain scores were recorded for 24 h. Patients in the study group received significantly less (P less than 0.03) morphine (0.32 mg.kg-1.24 h-1) and had significantly lower pain scores than did patients in the control group (0.71 mg.kg-1.24 h-1). The mean duration of complete analgesia in patients receiving caudally administered morphine was 6 h (range 2-12), but decreased analgesic requirements were noted for the entire 24 h. No respiratory depression was evident by clinical variables or repeated arterial blood gas values. Nausea without vomiting occurred in 4/16 patients in the study group. No patient described pruritus. The authors were unable to evaluate the occurrence of urinary retention because all patients had indwelling urinary catheters. They found caudal epidural morphine to be safe and effective in the treatment of postoperative pain in children following open heart surgery.