Urinary Retention Research Articles

Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study.

This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy. This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume>150mL, determined by catheterization after spontaneous voiding. Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was>50mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133±447mL; all were nulliparous, seven had induced labor, and five had an episiotomy. Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4hours for women who are unable to urinate spontaneously, void less than 50ml, or experience complete motor blockade during labor.

Investigating Postoperative Urinary Retention: Risk Factors and Postsurgical Outcomes in Total Joint Arthroplasty.

Postoperative urinary retention (POUR), a known complication following total joint arthroplasty (TJA), remains inconsistent in its diagnostic criteria, prevalence, and risk factors. This study aims to quantify POUR rates, identify risk factors, and assess complications associated with catheterization in TJA. A single-center cohort undergoing TJA between January 2015 and December 2022 was retrospectively reviewed. POUR rates were quantified using 3 different diagnostic criteria. Variables analyzed included age, sex, alpha-blocker prescription, operative joint, body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index classification, and anesthesia type. Complication rates between POUR and non-POUR patients were compared. Among POUR patients, 90-day postoperative renal and infectious complications were evaluated based on catheterization type and frequency. Among the 17,220 TJA patients identified, POUR incidence rates varied from 20% (catheterization), 25% (postoperative bladder scan > 500 mL), to 29% (catheterization and/or bladder scan). Advanced age, male gender, lower body mass index, moderate Charlson Comorbidity Index scores, total knee arthroplasty, spinal anesthesia, and alpha-blocker use were significantly more prevalent among POUR patients. The development of postoperative complications, including renal/infectious complications, was not significant between POUR and non-POUR patients. Among POUR patients, there was a significant increase in renal/infectious complications among patients who received 4+ catheters (odds ratio= 10.17, 2.75, 37.59). Diagnostic variability in POUR after TJA persists. For POUR management, patients receiving 4+ catheters were at a 10-fold risk for renal/infectious complications compared to those without catheterization. Reducing catheterization frequency and employing risk stratification for susceptible patients may help mitigate these risks effectively.

60 Acute urinary retention in a 17-year-old male

60 Acute urinary retention in a 17-year-old male

Efficacy of 100-U Onabotulinumtoxin A Treatment in Female Idiopathic Overactive Bladder-A Prospective Follow-Up Study.

Overactive bladder (OAB) affects 11-17% of the female population. First-line treatment with lifestyle modifications and second-line therapy with medications are often limited by inadequate efficacy or pharmacological side effects. This study was aimed at assessing the effect of 100 U onabotulinumtoxin A treatment on idiopathic OAB (iOAB) as a second-line treatment. This prospective follow-up study involved 94 women who received onabotulinumtoxin A treatment at a dose of 100 U as a second-line treatment for iOAB at the Department of Obstetrics and Gynecology, Oulu University Hospital, Finland, between May 2018 and December 2023. The impact of the treatment on iOAB symptoms was evaluated 3 months after administration using self-reported symptoms and the following internationally validated questionnaires: Visual Analogue Scale (VAS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6). Postoperative complications were assessed. The follow-up data were obtained from 74 (78%) patients, of whom 66 (95.7%) reported a good outcome and 3 (4.3%) reported a poor outcome. Incontinence episodes, the number of incontinence pads needed, and daily micturitions were significantly reduced. For all questionnaires, the total scores decreased significantly after the treatment (VAS 8.27 ± 1.78 vs 3.50 ± 3.08, p < 0.001; IIQ-7 72.14 ± 20.55 vs 28.73 ± 29.40, p < 0.001; UDI-6 55.01 ± 18.86 vs 29.66 ± 22.03, p < 0.001). Postoperative urinary tract infection occurred in 9 patients (9.6%), whereas urinary retention occurred in 6 patients (6.4%). Onabotulinumtoxin A (100 U) demonstrates good effectiveness in the second-line treatment of female iOAB.

Which Technique is Preferable for Grade 2–3 Hemorrhoidal Disease: Laser vs. Rubber Band Ligation? A Retrospective Study

Abstract Background The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent laser hemorrhoidoplasty (LH) and rubber band ligation (RBL) due to grade 2–3 hemorrhoidal disease. Methods The results of patients who underwent LH and RBL between June 2020 and June 2023 for grade 2–3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). Results A total of 260 patients were included in the study, 166 of whom underwent RBL and 94 LH. Operation time, VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. LH has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p &lt; 0.001). Conclusıons LH and RBL both offer effective treatment options for grade 2–3 hemorrhoidal disease, with comparable recurrence rates and time to return to normal life. However, LH is associated with significantly less postoperative pain and analgesic use on the first postoperative day, potentially enhancing patient satisfaction.

Presacral Lipoblastoma Presenting With Urinary Retention.

Lipoblastoma is a rare fatty tumor that can uncommonly arise in the presacral space. When the lesions attain sufficient size, they can cause a multitude of infiltrative and obstructive symptoms. In this report, we present the case of a 1-year-old infant who presented with recurrent urinary retention for 4 months due to a large presacral lipoblastoma, which was successfully resected. This case is unique as it highlights the lesion's rare location in the presacral space and the possibility of such lesions presenting with urinary retention.

Catheterizations Reduced Following a Protocol Change for Postoperative Urinary Retention Following Total Joint Arthroplasty With Spinal Anesthesia.

Postoperative urinary retention (POUR) is a common concern after total joint arthroplasty (TJA). However, overdiagnosis of POUR by bladder scans may lead to unnecessary interventions and associated complications. The purpose of this study was to determine the viability of a selective bladder scanning protocol to reduce overdiagnosis of POUR following TJA. A study of 500 consecutive patients operated on by 13 surgeons underwent a novel bladder scanning protocol designed to reduce overdiagnosis of POUR (selective protocol) through selective bladder scanning of only patients symptomatic for urinary retention. The protocol was then compared with the previous bladder scanning protocol under which 500 patients received routine bladder scans following TJA regardless of symptoms. The primary outcome of interest was the catheterization rate. Chi-squared and Student t-tests were used for analyses. Catheterization rates were markedly reduced when following the novel protocol (46.6% standard versus 38.2% selective; P = 0.009). Prevoid bladder scan volumes were markedly higher in the selective protocol cohort (459 ± 278 mL, 746 ± 226 mL; P ≤ 0.001), whereas postvoid bladder scan volumes were the same (247 ± 250 mL, 243 ± 271 mL; P = 0.859). Preoperative evaluation of urinary problems, intraoperative urinary complications, postoperative urinary symptoms, and spinal medication type were similar in each cohort. Length of service, rate of same-day discharge, total surgical time, and readmission rate were also similar. The selective protocol led to a notable reduction in catheterizations when compared with the standard protocol. This was done safely, without increased rates of urinary-related complications during or following surgery. These findings suggest that the selective protocol should be considered as a viable alternative to reduce overdiagnosis of POUR in TJA patients.

Prevalence, Management, and Associated Risk Factors of Urolithiasis Among Patients in a Tertiary Care Hospital, Bathinda

Background: Urolithiasis, a prevalent condition affecting the urinary system, is defined by the production of mineral crystals in the renal system or urinary tract. The purpose of this study is to assess the prevalence, demographic distribution, prognostic variables, and management findings among patients with urolithiasis at Adesh Hospital in Bathinda. Methods: A six-month prospective observational study was conducted in the Department of Urology . The study comprised 170 individuals with urolithiasis.Data were collected on socio-demographic details, clinical history, risk factors, laboratory and radiological findings, treatment regimens, and therapeutic outcomes. Statistical analyses were performed to identify patterns and associations. Results: Among 1432 patients screened, the prevalence of urolithiasis was 11.8%. The condition was most prevalent in the 38–48 age group (26.5%), with a slight female predominance (52.4%). Stone sizes of 4–8 mm were most common (61.8%), and the interpole calyx was identified as the predominant stone site (34.1%). Calcium stones were the most frequent composition (77.1%). Risk factors included inadequate hydration (62.9%), high sodium intake (79.4%), obesity (40.6%), alcohol use (53.5%), and frequent NSAID use. Hypertension (28.2%) and fatty liver (22.4%) were notable comorbidities, with a family history present in 8.2% of cases. Treatment: Medical management primarily involved urinary alkalinizers like potassium citrate and citric acid (98.2%) and alpha-blockers such as tamsulosin (40.0%). Antibiotics, including levofloxacin (41.8%) and cefixime with potassium clavulanate (32.9%), were frequently prescribed. Rabeprazole with domperidone (64.1%) was the most utilized proton pump inhibitor. Significant symptom improvement was observed post-treatment, particularly in dysuria, urinary retention, hematuria, and straining (p &lt; 0.001). Conclusion: Urolithiasis is a significant health issue influenced by modifiable lifestyle factors and comorbidities. This study underscores the importance of early diagnosis, effective medical management, and patient education to address underlying risk factors. The findings provide valuable insights for improving clinical outcomes and guiding evidence-based treatment strategies for urolithiasis.

Development of a nomogram model to predict postoperative urinary retention risk after transabdominal preperitoneal inguinal hernia repair.

To explore independent risk factors and to establish a predictive model for postoperative urinary retention (POUR) following transabdominal preperitoneal inguinal hernia repair (TAPP). Between January 2017 and December 2023, 598 patients with inguinal hernia who underwent TAPP at the General Surgery Department of Zunyi Medical University Affiliated Liupanshui Hospital were enrolled in the study. Participants were randomly divided into training and validation sets (7:3 ratio). The training set was further divided into POUR and non-POUR groups (38 and 381 cases, respectively). Independent risk factors for POUR were screened by logistic regression analysis. A nomogram predictive model was established based on the independent risk factors. The model's predictive ability was evaluated. Logistic regression revealed recurrent hernia (P = 0.013, OR = 0.279, 95% confidence interval [CI]: 0.105-0.805), BPH (P = 0.002, OR = 5.09, 95% CI: 2.658-96.282), preoperative catheterization (P = 0.004, OR = 0.087, 95% CI: 0.012-0.370), operation time (P < 0.001, OR = 0.015, 95% CI: 1.006-1.023), and use of narcotic analgesics (P = 0.042, OR = 2.224, 95% CI: 1.021-5.222) as independent risk factors for POUR after TAPP. Discriminant analysis showed the training set AUC was 0.763 (95% CI: 0.684-0.842, P < 0.001) while that for the validation set was 0.812 (95% CI: 0.677-0.947, P < 0.001). The Hosmer-Lemeshow test was performed to assess calibration of the training (P = 0.696) and validation (P = 0.194) sets. Recurrent hernia, BPH, preoperative catheterization, operation time, and use of narcotic analgesics were identified as independent risk factors for POUR after TAPP. The nomogram model for risk prediction based on these factors has strong predictive performance and application prospect.

Functional disorders of the lower urinary tract in diabetes mellitus

Type2 diabetes mellitus is awell-known metabolic disease with increasing prevalence. Diabetic-related complications lead to different types of organ damage, some of which some of which are less well-known. In the lower urinary tract, acomplex interplay of neuronal, myogenic, and urothelial dysfunction leads to functional disorders of the lower urinary tract, with disorders of bladder storage and bladder emptying being in the forefront. In Germany, the number of patients with diabetes mellitus is estimated at over 8million, with up to 2million undiagnosed cases. Exact figures on diabetes-related dysfunction of the lower urinary tract are not available, partly because the early phase is often asymptomatic. Symptomatic patients often initially report symptoms of urgency, but later reduced sensitivity and ultimately afeeling of residual urine and urinary retention. Treatment options are limited, not always evidence-based, and often only evaluated in patients without diabetes. Behavioral therapy measures, drug therapy, peripheral neuromodulation, and catheter use such as single-use catheterization or permanent catheter diversion are used. In order to ensure optimal diagnosis and therapy, an understanding of the underlying pathologies and functional diagnostics is necessary.

The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis.

Excisional hemorrhoidectomy and stapled hemorrhoidopexy are 2 common procedures for treating symptomatic hemorrhoids. However, concerns persist regarding the risk of postoperative complications and their unclear prevalence in the literature. This systematic review aims to evaluate andcompare the prevalence of incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy. A systematic search of Medline, EMBASE, and CENTRAL identified studies published in the past 25years that reported incontinence after excisional treatments for hemorrhoids. Primary outcomes included early (<3months) and late (≥3months) fecal incontinence. Secondary outcomes included postoperative bleeding, urinary retention, and recurrence. Single-arm meta-analyses of proportions were performed using R with meta-regression. In total, 139 studies were included in the meta-analysis, including 68 randomized controlled trials with 8,445 participants and 71 observational studies with 22,687 participants. Early incontinence rates were 5.32% in randomized controlled trials (95% confidence interval, 2.74-8.51%) and 1.03% in nonrandomized controlled trials (95% confidence interval, 0.28-2.09%). Late incontinence rates were 2.48% in randomized controlled trials (95% confidence interval, 1.09-4.25%) and 1.44% in nonrandomized controlled trials (95% confidence interval, 0.71-2.37%). There was no significant difference in the risk of incontinence or other postoperative complications between stapled hemorrhoidopexy and excisional hemorrhoidectomy, both in randomized controlled trials and nonrandomized controlled trials. Incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy is uncommon, and there appears to be no significant difference in risk between the 2 procedures. However, considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies. Future research should standardize definitions and methods for assessing incontinence and include preoperative assessments to more accurately define the risks of complications associated with hemorrhoid surgery.

BHSeP14 A UK centre experience of day case robotic hernia surgery

Abstract We present our series of 82 robotic hernia repairs in a busy district general hospital over a two year period. Follow-up ranged from 5 to 24 months. Between 01 January 2022 and 31 December 2023 we performed 35 robotic ventral hernia repairs (19 incisional midline, 3 spigelian and 13 umbilical). All hernias were repaired with closure of the defect and mesh reinforcement in either a retro-rectus or sublay plane. Mean operating time from knife to skin to final suture was 123 min (range 58–310 min). Mean length of stay was under 24 h with 60% (21/35) of cases being done as day case procedures. Mean width of defect was 4 cm (range 1–8 cm). Complications occurred in 14% (5/35) of patients with 2 recurrences, 2 haematomas and 1 seroma. One mesh was explanted during haematoma evacuation in the immediate postoperative period. There were no cases of surgical site infection. Over the same time period we performed 47 robotic inguinal hernia repairs (35 unilateral, 12 bilateral). All were done via TAPP approach. Mean operating time was 73 min (range 49–113) for unilateral hernias and 111 min (range 67–146) for bilateral hernias. 75% (39/46) of cases were done as day surgery. Of the 7 patients admitted overnight 3 were planned admissions for social reasons. No patient stayed more than one night. Complications occurred in 4 patients; 3 patients went into urinary retention requiring catheterisation and 1 patient developed a seroma which was managed conservatively.

Hidden cause of paralysis: tight filum terminale in spinal cord injury without radiographic abnormality

ObjectiveTo explore the clinical characteristics and surgical treatment outcomes of spinal cord injury without radiographic abnormality (SCIWORA) in children.MethodsA retrospective analysis was conducted on the clinical data of four children diagnosed with SCIWORA who were admitted to the Neurosurgery Department of Qingdao Women and Children's Hospital from November 2022 to June 2024. All four pediatric patients underwent laminectomy for spinal canal decompression along with resection of the filum terminale. Postoperatively, a regimen including corticosteroids and mannitol was administered. Following hospital discharge, each child was subjected to clinical follow-ups, and the neurological recovery from spinal cord injury was evaluated utilizing the American Spinal Injury Association (ASIA) impairment scale.ResultsAmong the four patients, there was one male and three females, aged from 3 years and 2 months to 8 years. Two cases were due to low falls, one from a lower back injury, and one from a lumbar sprain. All patients had thoracolumbar injuries, with rapid progression of symptoms, including paralysis, sensory impairment, and urinary and fecal retention. Follow-up duration ranged from 3 to 24 months; three patients showed varying degrees of recovery in muscle strength and/or sensory function and bowel and bladder control, while one showed no improvement. One patient developed scoliosis and another presented with neurogenic bladder.ConclusionTethered cord syndrome may be a potential underlying cause of SCIWORA. For children with SCIWORA accompanied by tethered cord syndrome, we recommend early surgical intervention to perform laminectomy and release the tethered cord, which may aid in the recovery of neurological function.

Personalized optimization of systematic prostate biopsy core number based on mpMRI radiomics features: a large-sample retrospective analysis

BackgroundProstate cancer (PCa) is definitively diagnosed by systematic prostate biopsy (SBx) with 13 cores. This method, however, can increase the risk of urinary retention, infection and bleeding due to the excessive number of biopsy cores.MethodsWe retrospectively analyzed 622 patients who underwent SBx with prostate multiparametric MRI (mpMRI) from two centers between January 2014 to June 2022. The MRI data were collected to manually segment Regions of Interest (ROI) of the tumor layer by layer. ROI reconstructions were fused to form outline of the volume of interest (VOI), which were exported and applied to subsequent extraction of radiomics features. The t-tests, Mann-Whitney U-tests and chi-squared tests were performed to evaluate the significance of features. The logistic regression was used for calculating the PCa risk score (PCS). The PCS model was trained to optimize the SBx core number, utilizing both mpMRI radiomics and clinical features.ResultsThe predicted number of SBx cores was determined by PCS model. Optimal core numbers of SBx for PCS subgroups 1–5 were calculated as 13, 10, 8, 6, and 6, respectively. Accuracies of predicted core numbers were high: 100%, 95.8%, 91.7%, 90.6%, and 92.7% for PCS subgroups 1–5. Optimized SBx reduced core rate by 41.9%. Leakage rates for PCa and clinically significant PCa were 8.2% and 3.4%, respectively. The optimized SBx also demonstrated high accuracy on the validation set.ConclusionThe optimization PCS model described in this study could therefore effectively reduce the number of systematic biopsy cores obtained from patients with high PCS, especially for biopsy cores far away from suspicious lesions. This method can enhance patient experience without reducing tumor detection rate.

Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines

BackgroundGuillain-Barré syndrome (GBS) presents with progressive ascending weakness, but it can also present with dysautonomia such as tachycardia, blood pressure fluctuations, diaphoresis, ileus, and urinary retention. GBS patients with dysautonomia was observed to have longer hospital stays and higher mortality rates than those without dysautonomia. We aimed to determine the risk factors for dysautonomia and its manifestations among patients with GBS and compared their features to those without dysautonomia.MethodsWe conducted a 10 year-retrospective review of GBS patients admitted at the Philippine General Hospital. The patient demographics, comorbidities, GBS disability status scale (GBS-DS), GBS variants, parameters of dysautonomia, treatment, and outcome were recorded and analyzed. Simple and multiple logistic regression analysis were conducted to determine the factors associated with dysautonomia and the relationships were expressed using odds ratio.Results71 patients were included, and 49% developed dysautonomia. Hypertension and tachycardia were the most prominent manifestations. There was an increase in the odds of developing dysautonomia in a one-year increase in age (OR: 1.11, p = 0.001) and a point increase in GBS-DS (OR:1.65, p = 0.037) during admission. Pre-morbid hypertension (OR:0.13, p = 0.028) and alcoholism (OR: 0.17, p = 0.037) are shown to decrease the odds of developing dysautonomia. Although GBS patients with dysautonomia had longer hospital stay (12.33 days), it only predicts 5.5% of the variability.DiscussionsThe prevalence of cardiovascular manifestations was postulated from cardiosympathetic hyperactivity between arterial baroreceptors, cardiac parasympathetic fibers, and preganglionic sympathetic vasomotor fibers. The protective mechanism of premorbid hypertension could be attributed to the prior intake of antihypertensive medications, which mitigate cardiosympathetic fluctuations, while the protective effect of alcoholism needs to be further studied.ConclusionPatients who are older and with a high GBS-DS on admission, prompt close monitoring for the development of dysautonomia. The protective effects of premorbid hypertension and alcoholism needs further evaluation. The odds of developing pneumonia and being on a mechanical ventilator, while not statistically significant, could contribute to longer hospital stay of patients with dysautonomia. A larger prospective study is warranted to confirm these results.

Additive Value of Pyridostigmine to Silodosin in the Management of Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia: A Randomized Controlled Trial

Additive Value of Pyridostigmine to Silodosin in the Management of Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia: A Randomized Controlled Trial

Onabotulinum Toxin A-Led Urinary Tract Infections-Should we Safeguard? A Randomized Controlled Trial.

The objective of our study was to evaluate the need for antibiotic prophylaxis for urinary tract infection (UTI) prevention before Onabotulinum toxin A injection for overactive bladder (OAB). We hypothesize that the lack of antibiotic prophylaxis might not be inferior to administering prophylaxis. This was a multi-centered, nonblinded, randomized controlled trial conducted between August 2022 and September 2024. Participants were randomized to either receive oral antibiotics or no treatment. Our primary outcome was to measure the rate of UTI at 2weeks. Our secondary outcomes included post-void residuals, assessment for antibiotic compliance, and UTI rates at 6weeks. Given a 20% UTI rate and a delta of 20%, 64 participants per study arm were necessary to achieve 80% power with an alpha value of 0.05. Rates of UTI at 2weeks post-procedure were 9.2% in the antibiotics group and 10.9% in the control group (p = 0.75). UTI rates 6weeks post-procedure were 4.7% in the antibiotics group and 11.1% in the control group (p = 0.21). When analyzing variables such as age, race, body mass index, menopause status, vaginal estrogen use, or the rates of positive pre-procedure urine cultures, no factors proved to be predictors of developing a UTI at 2weeks post-procedure. The urinary retention rate in our study was 0.8%. Rates of UTI were not significantly different between patients who obtained antibiotics prophylaxis and those who did not at 2 and 6weeks following injection. Foregoing antibiotics prophylaxis in order to safeguard from the dangers of antimicrobial resistance may be considered in the treatment of OAB with Onabotulinum toxin A.

Development and validation of biopsy free nomograms for predicting clinically significant prostate cancer in men with PI-RADS 4 and 5 lesions

To develop and validate biopsy-free nomograms to more accurately predict clinically significant prostate cancer (csPCa) in biopsy-naïve men with prostate imaging reporting and data system (PI-RADS) ≥ 4 lesions. A cohort of 931 patients with PI-RADS ≥ 4 lesions, undergoing prostate biopsies or radical prostatectomy from January 2020 to August 2023, was analyzed. Various clinical variables, including age, prostate-specific antigen (PSA) levels, prostate volume (PV), PSA density (PSAD), prostate health index (PHI), and maximum standardized uptake values (SUVmax) from PSMA PET-CT imaging, were assessed for predicting csPCa. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration plots, and decision-curve analyses, with internal validation. The foundational model (nomogram 1) encompassed the entire cohort, accurately predicting csPCa by incorporating variables such as age, PSAD, PV, PSA ratio variations, suspicious lesion location, and history of acute urinary retention (AUR). The AUC for csPCa prediction achieved by the foundational model was 0.918, with internal validation confirming reliability (AUC: 0.908). Advanced models (nomogram 2 and 3), incorporating PHI and PHI + PSMA SUVmax, achieved AUCs of 0.908 and 0.955 in the training set and 0.847 and 0.949 in the validation set, respectively. Decision analysis indicated enhanced biopsy outcome predictions with the advanced models. Nomogram 3 could potentially reduce biopsies by 92.41%, while missing only 1.53% of csPCa cases. In conclusion, the newly biopsy-free approaches for patients with PI-RADS ≥ 4 lesions represent a significant advancement in csPCa diagnosis in this high-risk population.

Comparison of Complications and Outcomes Following Transurethral Resection of the Prostate in Patients Presenting With and Without Acute Urinary Retention

Comparison of Complications and Outcomes Following Transurethral Resection of the Prostate in Patients Presenting With and Without Acute Urinary Retention

Paediatric Acute Urinary Retention in Central Queensland.

The aetiology of paediatric acute urinary retention (PAUR) is poorly documented across English medical literature and none from Australasia. This study aimed to document incidence, aetiology and associated time to diagnoses and treatment of PAUR in regional Australia. This was a retrospective study of children aged 0-17 years at presentation to two regional hospitals from 01.01.2008-31.12.2018. Data were extracted from patient files following a search for documented cases of acute urinary retention. There were 56 presentations from 53 children with sex ratio (M:F) of 1.4:1. The median age at presentation was 5.9 (IQR 2.8, 13.3) years, with bimodal peaks at 2-4 years and 12-16 years. Using Poisson regression model, the population incidence increased over the period (p < 0.05). The commonest aetiologies were post-operative (13; 23%), medications excluding anaesthesia (7; 13%), urinary tract infection (UTI) (6; 11%) and phimosis/balanitis (6; 11%), faecal impaction (6; 11%), neoplasia (5; 9%) and uncertain (10; 18%). Time to diagnosis had a median of 3 (IQR 0,14.5) h and a mean of 9.2 (±13.7) h. Time to treatment had a median of 0 (IQR 0,2.5) h and a mean of 3.6 (±11.2) h. Most cases (43/47; 92%) had successful urethral catheterisation, with one requiring suprapubic tap. Nine cases (16%) spontaneously resolved. Analgesia was provided in 49 cases (88%). Majority (40; 71%) were discharged and 15(27%) cases referred. The most common aetiologies for PAUR were post-operative causes, medication use, UTI, phimosis/balanitis and faecal impaction, all providing opportunities for intervention. The incidence significantly increased over time. Diagnoses and treatment were early in most cases.