Acute Urinary Retention Patients Research Articles

Prostatic urethral lift for subjects in urinary retention (PULSAR): 12-Month results of a prospective controlled trial compared with real-world outcomes.

To examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and real-world setting (Real-World Retrospective study). PULSAR was a 12-month prospective study of PUL in AUR patients (n = 51) performed at six centres in the United Kingdom; enrolled BPH patients aged ≥50 years, with prostate volume of ≤100 cc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alpha-blocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheter-dependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure. Seventy-three percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12 months post-PUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheter-independent rates (80%) were seen in RWRr patients; variables that influenced success included age <70 years, lower baseline prostate-specific antigen (PSA), lower baseline post-void residual (PVR) and shorter pre-procedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70 years and higher bladder voiding efficiency (BVE) were associated with success. Lower baseline PSA and PVR, younger age and shorter pre-procedure catheter durations drove successful outcomes in AUR patients undergoing PUL. Post-PUL voiding efficiencies may help ascertain long-term response to treatment.

MP76-17 SUCCESSFUL OUTCOMES IN ACUTE URINARY RETENTION (AUR) PATIENTS TREATED WITH THE PROSTATIC URETHRAL LIFT (PUL) ARE ASSOCIATED WITH EARLIER INTERVENTION

You have accessJournal of UrologyCME1 Apr 2023MP76-17 SUCCESSFUL OUTCOMES IN ACUTE URINARY RETENTION (AUR) PATIENTS TREATED WITH THE PROSTATIC URETHRAL LIFT (PUL) ARE ASSOCIATED WITH EARLIER INTERVENTION Oliver (Olly) Kayes, Neil Barber, Rajesh Kavia, Toby Page, Nikesh Thiruchelvam, Gregg Eure, and Mark Rochester Oliver (Olly) KayesOliver (Olly) Kayes More articles by this author , Neil BarberNeil Barber More articles by this author , Rajesh KaviaRajesh Kavia More articles by this author , Toby PageToby Page More articles by this author , Nikesh ThiruchelvamNikesh Thiruchelvam More articles by this author , Gregg EureGregg Eure More articles by this author , and Mark RochesterMark Rochester More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AUR represents a subset of difficult patients with BPH-LUTS who require rapid restoration of voiding. Shifting to a day case procedure such as PUL with demonstrated safety and efficacy in AUR patients, may accelerate treatment pathways without compromising patient outcomes. As such, appropriate selection criteria are desired to help urologists better gauge how AUR patients may respond to PUL. Here, we examine patient and procedural characteristics that underpin treatment success in AUR patients who underwent PUL. METHODS: A logistical regression model was constructed to evaluate factors associated with outcomes predicting success following PUL (i.e., catheter and surgery free at 12 months). Covariates for subjects in the PULSAR study (single arm PUL in AUR; n=51) as well as retention patients in the real-world registry (RWRr; n=388) included age, prostate volume, proxies of BPH disease severity (IPSS, IPSS QoL, Qmax, PSA, PVR), medical history (duration of catheterization), and procedural details (implants placed, procedure time, voiding efficiency). Results were reported as odds ratio point estimates with statistical significance quantified using chi-squared tests. RESULTS: After PUL, 73% of PULSAR subjects were catheter and surgery free at 12 months with success associated with higher voiding efficiency during the perioperative period. Slightly higher catheter-free rates (80%) were seen in RWRr patients and variables that influenced success encompassed age <70 years at procedure, lower baseline PSA, lower baseline PVR, and shorter pre-procedural catheter duration. Logistic regression for the combined PULSAR and RWRr retention groups revealed success associated with procedural age <70 yr and higher voiding efficiency. Stepwise multivariate regression analysis did not reveal any significant associations (Table 1). CONCLUSIONS: Advanced age, higher baseline PSA and PVR, and longer pre-procedure catheter durations drive suboptimal PUL outcomes in AUR patients. Voiding efficiencies following PUL may also help to ascertain long-term response after treatment. In men deemed suitable for PUL treatment, these new selection criteria may provide more men in AUR with earlier access to safe and effective BPH surgery. Source of Funding: Teleflex, Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1098 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oliver (Olly) Kayes More articles by this author Neil Barber More articles by this author Rajesh Kavia More articles by this author Toby Page More articles by this author Nikesh Thiruchelvam More articles by this author Gregg Eure More articles by this author Mark Rochester More articles by this author Expand All Advertisement PDF downloadLoading ...

Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database.

The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation. A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared twogroups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis. In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate. Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

Acute urinary retention: causes, risk of complications, treatment methods (literature review)

Acute urinary retention (ischuria) is a pathological condition caused by the impossibility of emptying the bladder. The ischuria prevalence in men prevails over the prevalence of this pathology in women. The leading causes of acute urinary retention (AUR) in men are benign prostatic hyperplasia, early postoperative period, prostate cancer, and medications. AUR patients need emergency care, which consists of bladder decompression. The first stage of treatment (decompression) can be performed in three ways: catheterization, suprapubic capillary puncture, or epicystostomy. The second and third stages consist of the diagnosis and treatment of the underlying disease. The choice of treatment method depends on the patient's condition, his underlying disease and possible complications.

Molecular mechanisms of voiding dysfunction in a novel mouse model of acute urinary retention.

Acute urinary retention (AUR) is a common urological emergency and affects a significant patient population. The inability to eliminate urine may lead to permanent damage to the bladder's structure and functioning. However, we know little about the underlying molecular sequelae to the urine retention. To closely mirror the potential high pressures that patients with AUR could experience, we catheterized anesthetized female mice via the urethra and filled the bladder by pumping saline (25 µL/min) into the bladder lumen to 50 cm or 80 cm water pressure. A water column with designated height (50 or 80 cm) was then adjusted to maintain constant pressure in the bladder lumen for 30 minutes. Functional and morphological evaluations were performed from 0 to 24 hours after AUR treatment. Mice exhibited incontinence and overactivity with diminished voiding pressure. Significant injury was confirmed which revealed bladders with disrupted urothelial barrier, edematous lamina propria, and distorted muscle bundles. Bladder smooth muscle (BSM) from pressure-treated mice have significantly diminished contraction force, suggesting that bladder voiding dysfunction can be attributed to impaired BSM contractility. Indeed, dysregulation of acetylcholine and purinergic signaling pathways were demonstrated, indicating that reduced efficacy of these pathways contributes to impaired BSM contractility. Finally, altered expression of β1-integrin and extracellular matrix mediated mechanotransduction pathways were detected, suggesting a profound remodeling process. These data demonstrated an easy to perform, quantifiable, and reproducible AUR mouse model, which mimics well the characteristics of human AUR patients, and our data generate new insights into the molecular mechanisms that occur following AUR.

PD29-07 DISPARITIES IN BPH PROGRESSION: PREDICTORS OF PRESENTATION TO THE EMERGENCY DEPARTMENT IN URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation (PD29)1 Apr 2020PD29-07 DISPARITIES IN BPH PROGRESSION: PREDICTORS OF PRESENTATION TO THE EMERGENCY DEPARTMENT IN URINARY RETENTION Parth M. Patel, Sarah E. Sweigert*, Marc Nelson, Gopal Gupta, Marshall Baker, Francois Modave, and Kevin T. McVary Parth M. PatelParth M. Patel More articles by this author , Sarah E. Sweigert*Sarah E. Sweigert* More articles by this author , Marc NelsonMarc Nelson More articles by this author , Gopal GuptaGopal Gupta More articles by this author , Marshall BakerMarshall Baker More articles by this author , Francois ModaveFrancois Modave More articles by this author , and Kevin T. McVaryKevin T. McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000893.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (LUTS/BPH) is an age-related process that can progress to acute urinary retention (AUR). Currently, no studies have evaluated what groups of patients present to the ED with AUR, the regional distribution, or the socioeconomic and demographic factors therein. We utilized a population-level administrative dataset to retrospectively evaluate patients who presented to the emergency room with AUR secondary to BPH. METHODS: Using the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD), we conducted a retrospective cohort study of patients who presented to emergency departments in Florida between 2005 and 2015. Male patients above 45 years of age who presented with diagnosis codes for both AUR and LUTS/BPH were considered. Information was collected on age, race/ethnicity, primary insurance, and rural-urban commuting area (RUCA) codes. RESULTS: The mean age for patients presenting with AUR was 72.2 years, 10.6 years older than those presenting for non-urologic complaints (p < 0.001). A significantly higher proportion of AUR patients had Medicare insurance (68.9% versus 41.7%, p < 0.001). Greater proportions of the AUR patients belonged to urban RUCA codes (93.2% versus 91.3%, p < 0.001). On multivariable analysis adjusted for measured confounders, all covariates of interest demonstrated significance. The risk of presenting to the ED for AUR from LUTS/BPH increased with age, with the 75-85 year age-group at the highest risk (OR 15.96, p<0.001). Other factors associated with presentation to the ED with AUR included African-American (OR 1.15, p<0.001) or Hispanic (OR 1.75, p<0.001) race, Medicare (OR 1.27, p<0.001) or private (OR 1.33, p<0.001) insurance, and urban RUCA codes (OR 1.31, p<0.001). CONCLUSIONS: Male patients older than 45 who presented to the ED for AUR with BPH were more likely to be older, of non-white race, have Medicare or private insurance, and live in more urbanized areas. We surmise that African-American and Hispanic patients may be untreated or undertreated for BPH in the outpatient setting, resulting in an increased risk of presentation to the ED with AUR. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e620-e620 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parth M. Patel More articles by this author Sarah E. Sweigert* More articles by this author Marc Nelson More articles by this author Gopal Gupta More articles by this author Marshall Baker More articles by this author Francois Modave More articles by this author Kevin T. McVary More articles by this author Expand All Advertisement PDF downloadLoading ...

Blood Urea and Creatinine Levels in Obstructive Uropathy Patients Due to Benign Prostate Hyperplasia after Transurethral Resection of the Prostate

Purpose: To evaluate blood urea and creatinine levels in obstructive uropathy patients due to acute urinary retention due to benign prostate hyperplasia (BPH) and two weeks after transurethral resection of the prostate (TURP). Method: We reviewed medical records of obstructive uropathy patients due to BPH and underwent TURP from January 2010 to December 2015 in Arifin Achmad Regional General Hospital, Pekanbaru, Riau Province, Indonesia. Data collected were acute urinary retention patients due to BPH, the blood urea and creatinine levels soon after urinary catheter insertion and the blood urea and creatinine levels. The statistical analysis of univariate and bivariate were used. Approval on the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau. Results: There were 88 obstructive uropathy patients due to benign prostatic hyperplasia in which commonly occurred in age 61-70 years old group. This study also showed 84 (95.5%) cases of obstructive uropathy due to BPH underwent TURP experienced decrease in blood urea levels with creatinine levels to normal limits. Conclusions: There were improvement of kidney function after TURP in obstructive uropathy patients due to BPH.

MP35-15 CLINICAL FEATURES OF HYDRONEPHROSIS IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA AND ACUTE URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2016MP35-15 CLINICAL FEATURES OF HYDRONEPHROSIS IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA AND ACUTE URINARY RETENTION Chin-Heng Lu, Howard Hong-Hao Wu, Yu-Hua Fan, Chih-Chieh Lin, Yi-Hsiu Huang, Tzu-Ping Lin, Hsiao-Jen Chung, Junne-Yih Kuo, William Jhih-Sian Huang, Yen-Hua Chang, Alex Tong-Long Lin, and Kuang-Kuo Chen Chin-Heng LuChin-Heng Lu More articles by this author , Howard Hong-Hao WuHoward Hong-Hao Wu More articles by this author , Yu-Hua FanYu-Hua Fan More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Junne-Yih KuoJunne-Yih Kuo More articles by this author , William Jhih-Sian HuangWilliam Jhih-Sian Huang More articles by this author , Yen-Hua ChangYen-Hua Chang More articles by this author , Alex Tong-Long LinAlex Tong-Long Lin More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1607AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Some benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) hesitated to receive surgical treatment till acute urinary retention (AUR) occurred. Part of them combined hydronephrosis which induced renal insufficiency. Many studies had analyzed risk factors for predicting acute urinary retention and other associated complications in benign prostatic obstruction (BPO) patients. This study aimed to predict what kind of patients who needed transurethral resection of the prostate (TURP) for AUR tended to accompany with hydronephrosis. METHODS We retrospectively evaluated 91 patients who had benign prostate obstruction (BPO) and received TURP for acute urinary retention from January 2014 to June 2015. Exclusion criteria including the patient had urolithiasis, prostate cancer, bladder cancer or gross hematuria. Parameters of intravesical prostatic protrusion (IPP), bladder wall thickness (BWT), serum PSA, total prostate volume, age, BMI, HTN, DM, CAD, serum creatinine and the results from the pressure-flow study (UFR) and cystometrogram (CMG) results were compared between the hydronephrosis group (n=24) and non-hydronephrosis group (n=67). RESULTS The There were significant differences in BWT (p<0.001), IPP (p<0.001) and Cr (p<0.001) between the hydronephrosis and non-hydronephrosis groups. For BWT, the area under the curve was 0.947 (95% confidence interval, 0.888 to 1.000, P<0.0001) and the cutoff value to indicate hydronephrosis was 0.75 mm with 88.0% sensitivity and 91.9% specificity. The odds ratio was 83.6 (95% confidence interval, 18.403 to 379.774). For IPP, the area under the curve was 1.950 (95% confidence interval, 0.720 to 0.344, P<0.0001) and the cutoff value to indicate hydronephrosis was 1.95 mm with 72.0% sensitivity and 65.6% specificity. The odds ratio was 4.909 (95% confidence interval, 1.781 to 13.533) There were no significant differences in age, BMI, DM, HTN, CAD, pre-TURP, PSA, UFR between the 2 groups. IPP was weakly correlated with total prostate volume (p=0.423). There was no significant differences for a specific type of CMG result but 42.3% AUR patients showed overactivity bladder. CONCLUSIONS Clinical parameters of BWT and IPP were significant risk factors for predicting hydronephrosis in BPO patients. If patients’ BWT exceeding 0.75 cm or IPP exceeding 1.95 cm, they have highly risk for combination of hydronephrosis when AUR occurred. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e486 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Chin-Heng Lu More articles by this author Howard Hong-Hao Wu More articles by this author Yu-Hua Fan More articles by this author Chih-Chieh Lin More articles by this author Yi-Hsiu Huang More articles by this author Tzu-Ping Lin More articles by this author Hsiao-Jen Chung More articles by this author Junne-Yih Kuo More articles by this author William Jhih-Sian Huang More articles by this author Yen-Hua Chang More articles by this author Alex Tong-Long Lin More articles by this author Kuang-Kuo Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Application effects of functional rehabilitation gymnastics combined with glycerini enema for acute urinary retention patient′s prognosis

Objective To explore the application effects of functional rehabilitation gymnastics combined with glycerini enema for acute urinary retention patient′s prognosis. Methods A total of 120 acute urinary retention patients were selected and averagely divided into observation group and control group according to random lottery, and all patients poured into glycerini enema, but the patients of observation group received extra intervention of functional rehabilitation gymnastics with 15 d intervention period. The interventions effects were compared between two groups. Results After interventions, the difference of effective rates was statistically significant between two groups (P<0.05). The residual urine volume in the observation group was lesser than that of the control group, the bladder pressure-volume of the observation group was ligher than that of the control group (P<0.05). Conclusions Functional rehabilitation gymnastics combined with glycerini enema can be applied for acute urinary retention patient′s prognosis and relieve the pain, so as to enhance the quality of life. Key words: Urinary retention; Rehabilitation nursing; Functional rehabilitation gymnastics; Glycerini enema

Teaching of intermittent self-catheterisation through dedicated nurse-led TOV clinic for patients with uncomplicated acute urinary retention: How useful is it in practice?

Objectives: Acute urinary retention (AUR) is a common urological emergency. Our institution has established an outpatient pathway for managing patients with uncomplicated AUR on discharge from A&amp;E: with catheter education and alpha-blocker therapy. They are followed up in a nurse-led clinic where intermittent self-catheterisation (ISC) can be taught if required. The aim of this study is to investigate the outcomes of our nurse-led trial of void (TOV) clinic and specifically the merit of teaching ISC. Methods: Data was prospectively collected and analysed for all patients with AUR who were followed up in the nurse-led TOV clinic between October 2012 and December 2014. Results: Over 26 months, 120 men with AUR attended the TOV clinic with an average age of 71 years (range 28–94 years). Forty-nine of 120 (41%) patients had an identifiable cause for AUR (UTI=13, constipation=13, alcohol=11, anti-cholinergics=7, post-operative=4 and post-brachytherapy=1). Sixty-four men passed and 50 failed TOV. Six were excluded from this analysis as they did not proceed to TOV in clinic (three requested LTC and three were not appropriate for outpatient clinic). All 50 patients who failed TOV were offered ISC. Thirty-two of 50 patients (64%) learnt ISC. Ten declined and eight were unable to perform ISC. Only seven of 50 patients (14%) went on to have a TURP, four of whom had declined to learn ISC. Of the remaining 43 patients, 24 (56%) had return of spontaneous voiding. Conclusion: In our experience, a pathway for reviewing AUR patients in a nurse-led TOV clinic where expertise for ISC tuition is available is extremely useful. In our series, only 14% of patients who failed TOV required TURP. Bladder function often returns to normal over time but ISC offers patients an autonomous management option if satisfactory to themselves whilst avoiding the complications of LTC.

Application of Bladder Scan in Ambulatory Management Protocol for Acute Urinary Retention with Presumed Diagnosis of Benign Prostatic Hypertrophy

Objective Bladder scan was firstly used in the ambulatory management protocol for acute urinary retention (AUR) in Princess Margaret Hospital (PMH) emergency department (ED) since 2012. Bladder scan measurement was performed immediately after triage for early catheterisation in the new protocol for AUR. The primary objective of this study was to evaluate the accuracy of bladder scan in estimating the volume of urinary retention. The secondary objectives were to evaluate the change in unnecessary catheterisation rate and the change in door to catheterisation time (DTCT) after the implementation of new protocol. Setting Emergency department of a regional hospital. Methods Male patients over 40 years old presenting to the ED of PMH for difficulty to void within the study period were enrolled and managed according to the study protocol. Agreement analysis was carried out by the Bland and Altman method. The changes in DTCT were assessed by comparing data of current study and historical control. Results A total of 121 male patients were recruited. The bias between bladder scan readings and catheterised volume was 26.09 ml when the average bladder scan measurement and catheterised volume was 300ml. The 95% upper and lower limit were -95.82 ml and 151 ml, respectively. The relative risk reduction of unnecessary catheterisation was 90.9%. The absolute risk reduction was 8.26%. Number need to treat was 12 (95% CI 8-30). The DTCT of current study were shorter than that of historical control (DTCT: 22.85 minutes vs. 48.42 minutes; p&lt;0.001). Conclusions Agreement between bladder scan readings and catheterised volume is satisfactory. Bladder scan can serve as a device to facilitate nurses to make decision on early catheterisation for AUR patients with presumed diagnosis of benign prostatic hypertrophy. (Hong Kong j.emerg.med. 2014;21:300-307)

Randomized controlled trial on the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention associated with benign prostatic hyperplasia

Objective.The aim of this study was to investigate the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH). Material and methods. In total, 845 consecutive patients with their first episode of spontaneous AUR associated with BPH were enrolled in this prospective randomized controlled trial. They were randomly assigned to be given either pharmacological treatment combined with bladder training or pharmacological treatment (tamsulosin 0.2 mg and finasteride 5 mg once daily) with free drainage of urinary catheter for 7 days, and a trial without catheter (TWOC) was performed. Data on patients' baseline demographics, history of BPH, International Prostate Symptom Score, prostate size, serum prostate-specific antigen, intravesical prostatic protrusion, TWOC success rates and related complications were collected and statistically analysed. Results.The two groups of spontaneous AUR patients with BPH were given pharmacological treatment combined with bladder training before catheter removal (n = 440) or pharmacological treatment alone (n = 405) for 7 days. All 845 patients underwent a first TWOC with an overall success rate of 66.9% after first 7 days' catheterization; TWOC was successful in 65.2% of cases in the intervention group and 68.6% in the control group. There was no statistically significant difference in TWOC success rate between the two groups (p > 0.05). Conclusion. This randomized controlled trial showed that bladder training before urinary catheter removal did not increase the chance of TWOC success significantly in spontaneous AUR patients with BPH.

Managing difficult emergency catheterization: what do urologists want?

Objectives: Acute urinary retention (AUR) is a common urological emergency; however, when approaching a difficult catheterization, this is an evidence-free zone. Our objective is to investigate current practice with the intent to reach a workable consensus for the management of patients in AUR who cannot be easily catheterized urethrally. Subjects: We performed a hypothetical scenario-based, multideanery survey with urology consultants and ST3+ trainees. Participants were asked how they would manage three patients who prove difficult to catheterize using standard methods: benign prostatic obstruction (BPO), urethral stricture, and meatal stenosis. Results: Of respondents, 38% ( n=23) indicated that a 16F curved-tip silicone catheter would be their first choice in managing a patient with BPO, followed by a suprapubic catheter (SPC) (20%, n=12) if this failed. SPC would be the first-line option for patients with a urethral stricture for 67% ( n=40) consultants, and for those with meatal stenosis, 60% would use a meatal dilator followed by SPC (22%, n=13) if this failed. Conclusion: Although there are general trends in preference towards managing a patient who is difficult to catheterize with AUR, there still remains considerable variation in practice due to lack of evidence in this area. We would recommend further multicentre data determining guidelines for best practice.

Predictive value of PSA and PSA density in the diagnosis of prostate cancer in patients with acute urinary retention

Objective To analyze the clinicopathological characteristics of patients transurethrally cathetered due to acute urinary retention (AUR) and with high prostate specific antigen (PSA),and to evaluate the value of PSA and prostate specific antigen density (PSAD) in the diagnosis of prostate cancer (PCa) in these patients.Methods Data from 95 patients who had been transurethrally cathetered due to AUR and underwent transrectally ultrasound-guided prostate biopsy were retrospectively analyzed.The indications for biopsy in this study were abnormally elevated serum levels of PSA,positive transrectal prostate ultrasound and/or magnatic resonance imaging findings,and abnormal digital rectal examination.The incidence of PCa was recorded according to total PSA levels,while receiver operating characteristic curve (ROC curve) was plotted for appraisement on the predictive value of PSAD.Results The positive biopsy rate was 17.9％ (17/95).The positive rate was 0 (0/21),6.1％ (2/33),13.0％ (3/23) and 66.7％ (12/18) for patients with PSA 4.1-10.0,10.1-20.0,20.1-50.0 and ≥50.1 μg/L,respectively.In patients with PSA≥ 10.1 μg/L,the area under ROC curve of PSAD was 0.935,and the optimal cutoff was ＞ 0.54 mg/L2,while corresponding sensitivity,specificity,positive predictive value,negative predictive value was 94.1％,84.2％,61.5％ and 97.9％,respectively.Conclusions Prostate biopsy should not be performed on all AUR patients with transurethral catheters and elevated PSA levels.Patients with PSA ≥10.1 μg/L and PSAD ＞ 0.54 mg/L2 are at higher risk of PCa diagnosis. Key words: Prostatic neoplasms ; Urinary retention ; Biopsy ; Urinary catheterization ; Prostate-specific antigen

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).

Detrusor Quantitative Morphometry in Obstructed Males and Controls

We studied the usefulness of computer assisted morphometry for measuring detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio in patients with bladder outlet obstruction, acute urinary retention and a nonobstructed control group. A prospective study was done in patients with bladder outlet obstruction undergoing transurethral prostate resection. Patients were divided into 33 with obstruction and 14 in acute urinary retention. A total of 15 males without obstruction undergoing transurethral prostate resection for bladder tumor formed the control group. Detrusor specimens were obtained during transurethral prostate resection. Detrusor muscle cell diameter was measured using light microscopy and a semiautomatic image analysis system. The connective tissue-to-smooth muscle ratio was automatically determined with computer assisted image analysis. Symptoms and urodynamic assessment were performed preoperatively and 6 months postoperatively. A total of 62 patients were included. The obstruction and acute urinary retention groups had a statistically higher detrusor muscle cell diameter and more fibrosis than the control group. Patients in acute urinary retention had more intrafascicular fibrosis (higher connective tissue-to-smooth muscle ratio at 40x magnification) than patients with obstruction. There were no differences in detrusor muscle cell diameter or interfascicular fibrosis (connective tissue-to-smooth muscle ratio at 10x magnification) between the obstruction and acute urinary retention groups. Detrusor muscle cell diameter correlated with symptom duration and functional recovery after transurethral prostate resection. Detrusor fibrosis correlated with preoperative detrusor pressure at maximum flow and postoperative compliance. Patients in acute urinary retention had fewer symptoms and higher residual volume. Other urodynamic parameters and their improvement after surgery were similar in the acute urinary retention and obstruction groups. Morphometric differences in detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio were observed between controls and patients with obstruction. There is an increase in detrusor muscle cell diameter and fibrosis in bladder outlet obstruction and more intense intrafascicular collagen deposition in patients in acute urinary retention.

RE: ALFUZOSIN ONCE DAILY FACILITATES RETURN TO VOIDING IN PATIENTS IN ACUTE URINARY RETENTION

No AccessJournal of UrologyLetters to the Editor1 Jul 2005RE: ALFUZOSIN ONCE DAILY FACILITATES RETURN TO VOIDING IN PATIENTS IN ACUTE URINARY RETENTION S.A. McNeill, and T.B. Hargreave S.A. McNeillS.A. McNeill More articles by this author , and T.B. HargreaveT.B. Hargreave More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)60147-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RE: ALFUZOSIN ONCE DAILY FACILITATES RETURN TO VOIDING IN PATIENTS IN ACUTE URINARY RETENTION." The Journal of Urology, 174(1), pp. 398–399 References 1 : Influence of age on outcome of trial without catheter (TWOC) during alfuzosin 10 mg OD therapy in patients with acute urinary retention (AUR) related to BPH. J Urol2004; 171: 360. abstract 1366. Link, Google Scholar 2 : Natural history of prostatism: risk factors for acute urinary retention. J Urol1997; 158: 481. Link, Google Scholar © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 1July 2005Page: 398-399 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information S.A. McNeill More articles by this author T.B. Hargreave More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bladder Blood Flow and De-Obstructive Open Prostatectomy: Correlation with Clinical and Urodynamic Parameters

To assess the relation between tissue blood flow changes during surgery with clinical and urodynamic parameters in obstructed patients. A prospective study was conducted in 18 symptomatic patients with bladder outlet obstruction undergoing retropubic prostatectomy. A symptom assessment and a preoperative urodynamic study were performed. To measure bladder blood flow a BLF-10 laser Doppler flowmeter and a blunt-tipped probe were used intraoperatively. Tissue flow was measured in TPU units (1 TPU unit=1 ml per minute per 100 mg of tissue). Six measurements were taken: two control in the rectus abdominis muscle and four in the detrusor, two before the incision of the prostatic capsule and two after closure. For the statistical analysis, Wilcoxon test and a regression analysis were performed. Mean age was 70 years (range: 56-84). Six patients had an episode of acute urinary retention (AUR). No differences were found in the initial and final values of bladder blood flow of the rectus muscle and the bladder dome. A decrease of bladder blood flow in the anterior bladder wall was observed after prostate enucleation. AUR patients showed no differences in bladder blood flow values. Bladder blood flow (BBF) changes showed no correlation with any urodynamic or clinical parameter. Laser Doppler flowmetry is useful to study BBF with low morbidity, ease of use and reproducibility. Following de-obstructive surgery, a decrease in BBF occurs, probably associated with surgery. These changes are similar in patients with and without AUR and show no correlation with other parameters studied.

Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia

To evaluate the efficacy of tamsulosin compared to placebo for treating catheterized patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH), by comparing the numbers of patients who voided successfully after removing their catheter. This was a randomized, double-blind, placebo-controlled, parallel-group, multicentre study. Men with AUR secondary to BPH were catheterized and then, if they fulfilled the entry criteria, were randomly assigned to receive either 0.4 mg tamsulosin hydrochloride in a modified-release capsule once daily, or a placebo. After up to eight doses the catheter was removed and the ability to void unaided assessed. In all, 149 men (mean age 69.4 years) were randomly assigned to receive tamsulosin (75) or placebo (74); eight were not evaluable, so the intent-to-treat population was 141 men. Thirty-four men taking tamsulosin and 18 taking placebo did not require re-catheterization on the day of the trial without catheter (48% and 26% respectively, P = 0.011; odds ratio 2.47, 95% confidence interval, CI, 1.23-4.97). Success using free-flow variables was also higher in the men who received tamsulosin, at 37 (52%) vs 24 (34%) on placebo (P = 0.019; odds ratio 2.34, 95% CI 1.15-4.75). Withdrawals were high (120 men, 81%), mostly because of a need for re-catheterization (89 men, 60%). Dizziness and somnolence occurred in seven (10%) and four (6%) men who received tamsulosin, and two (3%) who received placebo, but overall the incidence of adverse events was similar in the two groups. One patient died from carcinomatosis. Men catheterized for AUR can void more successfully after catheter removal if treated with tamsulosin, and are less likely to need re-catheterization. The side-effect profile was similar for tamsulosin and placebo, and consistent with known pharmacology. From these results tamsulosin can be recommended for treating men after catheterization for AUR, and can reduce the likelihood of the need for re-catheterization.

Does Ultrastructural Morphology Of Human Detrusor Smooth Muscle Cells Characterize Acute Urinary Retention?

Acute urinary retention is relatively rare in otherwise healthy men. The condition may be attributable to a combination of obstruction and detrusor hypocontractility. We determined whether acute or chronic urinary retention is accompanied by characteristic ultrastructural features in bladder detrusor smooth muscle cells and whether any of these ultrastructural features may be useful for classifying these conditions. Bladder biopsies of 15 men, including 13 in acute and 2 in chronic urinary retention, and 6 controls were examined by transmission electron microscopy. They were semiquantitatively and morphometrically analyzed for degenerative changes, cellular hypertrophy, variations in intercellular distances, abnormal cell junctions and configurations, and intracellular changes. No significant ultrastructural features were noted in the detrusor muscle of patients in acute urinary retention compared with controls. We cannot confirm the reports of others that characteristic ultrastructural features in smooth muscle cells accompany bladder outlet obstruction and detrusor hypocontractility.