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PubMed1999

Prevention of postherniorrhaphy urinary retention with prazosin.

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of alpha receptors in the bladder neck and urethral sphincter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

Adrenergic alpha-Antagonists↗

PubMed2002

Does ultrastructural morphology of human detrusor smooth muscle cells characterize acute urinary retention?

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: No significant ultrastructural features were noted in the detrusor muscle of patients in acute urinary retention compared with controls. CONCLUSIONS: We cannot confirm the reports of others that characteristic ultrastructural features in smooth muscle cells accompany bladder outlet obstruction and detrusor hypocontractility.

Acute Disease↗

PubMed2005

Managing and preventing acute urinary retention.

Acute urinary retention (AUR), an uncomfortable and potentially dangerous condition, often occurs in men who have benign prostatic hyperplasia. Although the reported incidence of AUR varies in the literature, there are a number of events that are known to precipitate episodes of AUR, including ingestion of certain agents, infection, general anesthesia, and performance of various diagnostic genitourinary procedures. Because it is preferable to avoid the need for catheterization (and the associated risks) in men at high risk for AUR, certain measures have been studied as means to prevent AUR episodes. Specifically, alpha-blockers and 5-alpha-reductase inhibitors have been shown to reduce the incidence of initial and subsequent AUR episodes in certain at-risk men.

Journal Article↗

PubMed2002

Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention.

INTRODUCTION: Acute urinary retention caused by bladder outlet obstruction resulting from prostatic enlargement is one of the commonest causes for acute admission to urology wards. More recently, there has been a trend to commence treatment with alpha-blockers after catheterisation followed by a trial without catheter (TWOC), in the hope that surgery may be avoided in a significant proportion of patients. There is no conclusive evidence of the efficacy of this treatment. We conducted a study to evaluate the efficacy of using the alpha-blocker alfuzosin SR in patients with acute urinary retention. PATIENTS AND METHODS: All patients presenting with acute urinary retention to our unit were included in the trial. Exclusion criteria included patients with known bladder or prostate malignancy, bladder calculi, urinary tract infections, urethral stricture or patients on alpha-blockers. A total of 81 patients consented and were randomised. Sixty-two patients completed the study. The retention volume was recorded. Trial medicine was recorded on a twice-daily dose and the first TWOC was carried out after a minimum of three doses or 36 hours after admission. TWOC was considered successful on voiding with a residual volume of <200 ml. Unsuccessful patients were recatheterised and discharged home on trial medication, and called for a second TWOC after 2 weeks. Successful patients were continued on alpha-blockers and failures were put on the operating list for TURP. Patients on active treatments were reviewed at 2 year. RESULTS: Of the 34 patients treated with alfuzosin SR, 17 (50%) resumed voiding and of the 28 patients from placebo group, 16 (57%) voided successfully. All 33 patients were continued open labelled on alfuzosin SR 5mg BD. Out of 33 patients, 13 (43%) had TURP within first year after TWOC and three died due to various medical causes. Out of remaining 17 patients, 15 attended for follow-up. The mean peak flow rate was 8.4 ml/s and the mean residual volume was 112 ml. Six patients (40%) required TURP for severe lower urinary tract symptoms (LUTS). So out of 28 patients followed at 2 year, 19 (68%) had TURP. CONCLUSIONS: These data do not support the routine use of alpha-blockers in patients with acute urinary retention. Also continuing use of alpha-blockers does not seem to prevent further requirements of TURP, although larger studies are needed to support this.

Acute Disease↗

PubMedDate not supplied

An unusual presentation of urinary retention.

Patients with urinary retention frequently present to the emergency department (ED) for evaluation and treatment. Urinary retention is seen most often in males secondary to mechanical causes. However, other etiologies must be considered. We present an unusual case of a 35-year-old male who developed postcoital urinary retention secondary to urogenital diaphragm spasm.

Adult↗

PubMed1995

[Urinary retention secondary to surgical treatment of stress urinary incontinence].

A retrospective, descriptive study at the National Institute of Perinatology (INPer), was carried out. 401 records of patients with stress urinary incontinence who underwent surgical treatment, were reviewed. The objective of this study was to know the urinary retention rate. Urinary retention was present in 103 of 401 patients (25.68%). In modified Pereyra's procedure it was present in 67 of 195 (34.35%); in modified Burch's procedure, in 25 of 131 (19.08%); in Kelly's procedure in 9 of 70 (12.85%) and in 2 of 5 patients with sling procedure with polytetrafluoroethylene (Goretex). The problem of urinary retention was observed more frequently in vaginal surgery (modified Pereyra procedure and/or sling procedure).

Cephalosporins↗

PubMed2000

[Treatment of chronic urinary retention after surgical treatment of urinary incontinence with bladder neck transurethral resection].

OBJECTIVE: To evaluate the efficacy and safety of transurethral resection of the overcorrected posterior lip of the bladder neck in patients with chronic urinary retention after repair of incontinence. MATERIAL AND METHODS: Transurethral bladder neck resection was performed in 26 women with a median age of 59 years. Incontinence repair consisted of a Burch procedure in eight cases, a Raz procedure in eight cases, a Marshall-Marchetti-Krantz procedure in five cases, an aponeurotic sling in three cases and a synthetic sling in two cases. The median preoperative maximum urine flow rate was 11.5 ml/s and the median residual urine was 150 ml. Preoperative cystourethrography and cystoscopy revealed overcorrection of the bladder neck in each case. RESULTS: With a median follow-up of 39 months, 65.5% of patients were cured (resolution of symptoms, maximum urine flow rate greater than 15 ml/s and residual urine less than 50 ml), 23% were improved and 11.5% were considered to be failures. No complications or secondary urinary incontinence were observed. Patients not cured by this technique were treated by urethrolysis in three cases, Uroflow stent in one case and section of a Raz cervicocystopexy suture in one case. CONCLUSION: Transurethral bladder neck resection can be used as first-line treatment for chronic urinary retention after repair of incontinence, as it is an effective, rapid, minimally invasive technique not associated with any morbidity. Urethrolysis can always be performed in the case of failure.

Adult↗

PubMed2001

Acute urinary retention in children.

PURPOSE: Acute urinary retention is relatively infrequent in children. There are a variety of causes that are poorly defined in the literature, and they differ greatly from those seen most frequently in adults. We review our experience with pediatric patients presenting with urinary retention to 2 major metropolitan children's hospitals. MATERIALS AND METHODS: Records from Egleston and Scottish Rite Hospitals for Children were reviewed for a 6-year period for the diagnosis of urinary retention. Urinary retention was defined as inability to empty the bladder volitionally for greater than 12 hours with a volume of urine greater than expected for age ([age in years + 2] x 30 cc) or a palpably distended bladder. All cases resulting postoperatively and believed secondary to surgical dissection, narcotic use or immobility, and children previously diagnosed with chronic neurological disorders and voiding dysfunction or with reduced mental status were excluded from study. The majority of these encounters were emergency department visits specifically for acute urinary retention. RESULTS: We identified 53 children meeting these criteria, including 37 boys 6 months to 17 years old and 16 girls 1 to 17 years old. Etiologies included neurological processes in 17%, severe voiding dysfunction in 15%, urinary tract infection in 13%, constipation in 13%, adverse drug effect in 13%, local inflammatory causes in 7%, locally invading neoplasms in 6%, benign obstructing lesions in 6%, idiopathic in 6%, combined urinary tract infection and constipation in 2%, and incarcerated inguinal hernia in 2% of cases. Adverse drug effects and dysfunctional voiding were implicated 3 times as often in males than females (16% versus 6% and 19% versus 6%, respectively). Urinary tract infections were 6 times more common in females (31% versus 5%). Constipation and local inflammatory processes were twice as common in females than males (19% versus 11% and 12% versus 5%, respectively). Local neoplasms, benign obstruction and idiopathic causes were found exclusively in males. CONCLUSIONS: Urinary retention in children is a relatively rare entity but there is a significant incidence of neurological abnormalities in this population. If a clear reason for this condition cannot be delineated based on history, physical examination and laboratory assessment, these patients should undergo prompt neurological evaluation and appropriate imaging studies.

Acute Disease↗

PubMed1978

[High-grade Urinary retention in the upper urinary tract due to ovarian cysts].

The obstructive uropathy of the upper urinary tract the reason of which is to be searched e.g. in congenital malformation, concrements hindering the passage, strictures and tumors of the urinary tract itself as well as in growing and displacing processes of the adjoining organs have often been observed and described. More seldom this is suitable for benign expansive processes of the ovary. Especially smaller growing and displacing benign processes in the ovary area may result in considerable difficulties concerning differential diagnosis. It is reported on a case of chronic urinary retention with cystic changes of the ovary.

Adult↗

PubMed2005

Long term follow up of men with Alfuzosin who voided successfully following acute urinary retention*.

INTRODUCTION: Acute urinary retention (AUR) is one of the commonest causes of admission in urology ward and successful voiding with alpha-blockers has been reported. However, long-term efficacy of Alfuzosin, following an episode of AUR is lacking. This is a continuation of our earlier reported study. We report the results of a 4 year follow-up on patients who were on Alfuzosin SR 5 mg BD, following resumption of voiding after an episode of AUR. PATIENTS AND METHODS: A total of 33 patients voided successfully following AUR in our original study. These patients continued on Alfuzosin SR 5 mg BD and were assessed at 2 and 4 years. Symptomatic assessment was performed with IPSS and QOL symptom score and objective assessment was with urinary flow rate and post void residual volume. Patients who continued to deteriorate symptomatically and objectively or developed further AUR were listed for surgery. RESULTS: Out of 33 patients, 28 patients were followed up at 2 years (three patients died due to various medical reasons and two did not attend for follow-up). Nineteen patients (68%) underwent transurethral resection of prostate (TURP) for severe lower urinary tract symptom (LUTS) . The mean peak flow rate at 2 years was 8.4 ml/s and the mean residual volume was 112 ml. Ten patients attended for follow up at 4 years. The mean flow rate was 5.17 ml/s and the mean post-void residual volume was 101 ml. Four patients underwent TURP for severe outflow symptoms. At 4 years follow up 24 out of 30 patients (80%) on Alfuzosin needed TURP. CONCLUSIONS: These data do not support the long term use of alpha-blockers in patients who voided successfully after acute urinary retention.

Acute Disease↗

PubMed1991

Does alpha sympathetic blockade prevent urinary retention following anorectal surgery?

Urinary retention is the most common complication after anorectal surgery, with rates as high as 52 percent reported. With the trend toward early discharge, avoidance of this complication is particularly important. Perioperative fluid restriction and the use of short-acting anesthetics have been shown to be effective in decreasing postoperative urinary retention rates but are not applicable in all cases. Reflex sympathetic stimulation, possibly as a result of perianal pain, may lead to increased muscular tone of the internal sphincter at the bladder neck. This theory had led to the effective use of alpha-adrenergic blockade in the treatment of established cases of urinary retention after anorectal surgery, herniorrhaphy, and major pelvic surgery. However, the prophylactic role of alpha blockade after anorectal surgery has not been studied. In a double-blind, prospective, randomized study, 51 patients were treated with either prazosin and alpha-adrenergic blocker or placebo prior to and immediately after elective anorectal surgery. Urinary retention rates were similar in the two groups. At this time, prophylactic alpha-adrenergic blockade is not recommended for the prevention of urinary retention after anorectal surgery.

Anal Canal↗

PubMed2003

Tamsulosin reduces the incidence of acute urinary retention following early removal of the urinary catheter after radical retropubic prostatectomy.

OBJECTIVES: To determine the efficacy of tamsulosin in preventing acute urinary retention following early catheter removal after radical retropubic prostatectomy. METHODS: Between February 2000 and October 2000, cystography was performed on postoperative day 7 after radical retropubic prostatectomy by a single surgeon (group 1). Between September 2001 and August 2002, cystography was performed on postoperative day 8 after radical retropubic prostatectomy by the same surgeon (group 2). The protocol for performing cystography and assessment of extravasation was similar for both groups. Tamsulosin 0.4 mg was administered 3 days before and 4 days after cystography for all men in group 2. RESULTS: Of 179 cystograms in group 1, 135 (75%) revealed no extravasation, and the catheters were removed in 130 of these cases. Of 246 cystograms in group 2, 230 (93.5%) revealed no extravasation, and the catheters were removed in 229 of these cases. A significantly greater proportion of men in group 2 had no extravasation (P = 0.0007). The incidence of acute urinary retention in groups 1 and 2 was 10% and 2.6%, respectively (P = 0.0018). The incidence of anastomotic stricture was not significantly different between the two groups. CONCLUSIONS: Our data strongly suggest that tamsulosin significantly reduces the risk of acute urinary retention after attempts at early catheter removal following radical retropubic prostatectomy. Therefore, we recommend administering a 7-day course of tamsulosin therapy when attempting to remove the urinary catheter before postoperative day 8.

Acute Disease↗

PubMed1998

[Acute urinary retention in women].

Acute urinary retention in women is not a common problem. The incidence is 0.07 per 1000 inhabitants per year. The causes of acute urinary retention can be divided into four groups: obstructive, neurological, pharmacological and psychogenic. More than half of acute urinary retentions occur after surgery or parturition. The most common obstructive cause is a gynaecologic tumor. A psychogenic cause is a diagnosis per exclusionem. The treatment of the acute urinary retention has to be catheterisation before further investigation is done.

Acute Disease↗

PubMed2005

Structural assessment of the urethral sphincter in women with urinary retention.

PURPOSE: The pathophysiology of urinary retention in women is generally unknown but a subgroup of women with urinary retention have been diagnosed as having so-called primary disorder of sphincter relaxation on the basis of an abnormal urethral sphincter electromyogram. It was suggested this sphincter overactivity could lead to work hypertrophy of the urethral rhabdosphincter and in this study we looked for any evidence of such muscle fiber hypertrophy. MATERIALS AND METHODS: In 9 women 18 to 45 years old (mean age 31.6) with urinary retention and overactive urethral sphincter electromyogram, light and electron microscopy were used to examine core needle biopsies of the urethral rhabdosphincter taken under transvaginal ultrasound control. Of the 9 patients only 5 biopsies processed for light microscopy and 4 processed for electron microscopy contained striated urethral muscle fibers. The results of these biopsies were compared to the morphology of a control specimen from a postmenopausal woman without a history of urinary retention. RESULTS: On light microscopy the urethral rhabdosphincter fiber diameter did not differ among patients (mean average 7.6 mum), was less than that reported in the literature (15 to 20), but did not differ from that of the control (mean 9.9). In all patients electron microscopy showed excessive peripheral sarcoplasm with lipid and glycogen deposition, and sarcoplasmic accumulation of normal mitochondria. These ultrastructural abnormalities were not seen in the control. CONCLUSIONS: To our knowledge this is the first morphological description of the urethral rhabdosphincter in a subgroup of women with urinary retention. Mean rhabdosphincter fiber diameter was approximately the same in patients and controls. This study does not support the previous theory that urethral sphincter overactivity in a subgroup of women with urinary retention leads to work hyperplasia of urethral rhabdosphincter fibers. An alternative hypothesis is suggested.

Adolescent↗

PubMed1995

Urinary retention in sexually abused women.

Urinary retention is generally believed to be the result of neurogenic or non-neurogenic problems. In men, it is often caused by benign prostatic hypertrophy which can be treated by transurethral surgery.1 In women, however, studies have shown that urinary retention is usually caused by detrusor dysfunction rather than obstruction. Surgery on the urethra or bladder neck is, therefore, inappropriate and ineffective. Once the cause of retention has been determined (i.e whether neurogenic or non-neurogenic in origin), appropriate treatment can be decided upon. The most common neurogenic problems are diabetes mellitus, multiple sclerosis and spinal cord pathologies.(1) Patients with non-neurogenic etiology associated with urinary retention are often found to have psychosocial problems that inhibit detrusor activity causing psychogenic retention.1-4 Studies have found that woman with a history of psychosis, depression and stress/anxiety have a higher incidence of urinary retention than woman with no history of such conditions. Psychological problems involving the loss of loved one, recent marriage break-up, abortion, pelvic surgery, etc. have been found to contribute to the incidence of urinary retention. There is another group of women who may or may not exhibit psychological problems associated with psychogenic urinary retention, but who may develop the same physical manifestations. These women have been sexually abused and have not fully resolved or realized the trauma of the assault. This paper looks at four cases or urinary retention in sexually abused woman, the treatments used and the results and conclusions obtained.

Journal Article↗

PubMed2006

Response to daily 10 mg alfuzosin predicts acute urinary retention and benign prostatic hyperplasia related surgery in men with lower urinary tract symptoms.

PURPOSE: We analyzed the influence of treatment response on the risk of acute urinary retention and benign prostatic hyperplasia related surgery in 5,792 men complaining of lower urinary tract symptoms who were treated for 6 months with the selective alpha1-blocker alfuzosin at 10 mg once daily. MATERIALS AND METHODS: The influence of dynamic variables (International Prostate Symptom Score change and bother during treatment) and baseline variables (patient age, prior acute urinary retention managed conservatively, prostate specific antigen, International Prostate Symptom Score and bother severity) on the risk of acute urinary retention and benign prostatic hyperplasia related surgery was estimated using the Kaplan-Meier method and log rank test. The associated HR and 95% CI were calculated using Cox proportional hazard models. RESULTS: During alfuzosin treatment International Prostate Symptom Score improved by 3 or greater and greater than 6 points in 74.8% and 50.3% of men, respectively. In this unselected population, including 3.8% with prior unoperated acute urinary retention, the rate of acute urinary retention and benign prostatic hyperplasia related surgery events during treatment was low (0.5% and 1.1%, respectively). Men with stable or worsening International Prostate Symptom Score were at increased risk for acute urinary retention or surgery (HR 3.75, 95% CI 1.58 to 8.89, p = 0.003 and HR 4.71, 95% CI 2.69 to 8.24, p <0.001, respectively). Prior acute urinary retention was a strong predictor of acute urinary retention relapse and surgery (HR 10.35, 95% CI 4.29 to 26.08, p <0.001 and HR 3.57, 95% CI 1.59 to 7.98, p = 0.002, respectively). Bother score greater than 3 during treatment was the strongest predictor of surgery (HR 7.61, 95% CI 4.16 to 13.93, p <0.001). Prostate specific antigen had much less predictive value. CONCLUSIONS: This 6-month real life practice study shows that alfuzosin is associated with a low incidence of acute urinary retention and benign prostatic hyperplasia related surgery. It also suggests that responder status is the most important predictor of acute urinary retention and benign prostatic hyperplasia related surgery. Thus, first line treatment with alfuzosin may help select patients at risk for benign prostatic hyperplasia progression to optimize treatment.

Acute Disease↗

PubMed1995

Distal ureteral stone in a duplicated system causing urinary retention.

Ureteral calculi and urinary retention are common problems encountered by the urologist. However, they rarely occur concomitantly. Herein, we describe a case of a 40-year-old female patient who developed urinary retention as a result of ureteral stone disease. Specifically, an ectopic upper pole ureter in a completely duplicated system contained a 2 x 6-cm ureteral stone, which emanated from the orifice, filling the urethra. The stone caused voiding difficulties to the extent that the patient had to manipulate the stone manually in order to void. The stone eventually resulted in urinary retention. Management was accomplished by cystoscopy and electrohydraulic lithotripsy of the stone. Chemical analysis revealed calcium phosphate and struvite as the principal components of the stone.

Adult↗

PubMed2002

Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

Acute urinary retention (AUR) is one of the most undesirable events for elderly men with benign prostatic hyperplasia (BPH). This study was designed to test the clinical utility of ultrasonic measurement of bladder weight as a predictor of AUR. A total number of 160 men visited our clinic with lower urinary tract symptoms (LUTS) suggestive of BPH and underwent urodynamic studies, including transrectal ultrasonography of the prostate and the measurement of ultrasound (US) estimated bladder weight (UEBW). Among them, 31 (19.4%) presented to our clinic with AUR. From the thickness of the anterior bladder wall measured by transabdominal ultrasonography and the intravesical volume, UEBW was calculated, supposing the bladder to be a sphere. Between patients with and without AUR, there were significant differences for age (75.4 vs. 71.1 years, p < 0.005), prostatic volume (45.5 vs. 35.8 g, p < 0.05), transition zone (TZ) volume (29.4 vs. 20.2 g, p < 0.05), TZ index (0.606 vs. 0.493, p < 0.005) and UEBW (50.3 vs. 34.7 g, p < 0.0001). A receiver-operating characteristic curve analysis demonstrated UEBW to be superior to the other prostatic ultrasonic measures in identifying AUR. Patients with LUTS suggestive of BPH having UEBW greater than 35.0 g were 13.4 times as likely to suffer from AUR. The significant association of UEBW with an increased risk of AUR suggests that it would be promising as a noninvasive urodynamic parameter capable of identifying patients at increased risk of AUR.

Aged↗