-
British Journal of Hospital Medicine... Jan 2022Acute urinary retention is a common clinical presentation in emergency departments in the UK and is responsible for over 30 000 hospital admissions annually. Awareness...
Acute urinary retention is a common clinical presentation in emergency departments in the UK and is responsible for over 30 000 hospital admissions annually. Awareness of the latest advice and guidelines regarding its presentation, investigation and management is paramount to improve patient outcomes and reduce morbidity. Immediate management of acute urinary retention relies on timely bladder decompression by catheterisation. Knowledge of the routes and types of catheterisation, including the associated risks, complications and contraindications, is essential to allow rapid and early intervention, thus preventing further complications. Differences in the presentation of patients with acute urinary retention reflect varying aetiologies, the knowledge of which determines long-term management and prognosis.
Topics: Acute Disease; Humans; Prognosis; Urinary Bladder; Urinary Catheterization; Urinary Retention
PubMed: 35129387
DOI: 10.12968/hmed.2021.0278 -
American Family Physician Oct 2018Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine. The condition predominantly affects men. The most common causes are...
Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine. The condition predominantly affects men. The most common causes are obstructive in nature, with benign prostatic hyperplasia accounting for 53% of cases. Infectious, inflammatory, iatrogenic, and neurologic causes can also affect urinary retention. Initial evaluation should involve a detailed history that includes information about current prescription medications and use of over-the-counter medications and herbal supplements. A focused physical examination with neurologic evaluation should be performed, and diagnostic testing should include measurement of postvoid residual (PVR) volume of urine. There is no consensus regarding a PVR-based definition for acute urinary retention; the American Urological Association recommends that chronic urinary retention be defined as PVR volume greater than 300 mL measured on two separate occasions and persisting for at least six months. Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization. Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term; silver alloy-coated and antibiotic-impregnated catheters offer clinically insignificant or no benefit. Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials. Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists.
Topics: Adrenergic alpha-Antagonists; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Curriculum; Education, Medical, Continuing; Female; Humans; Male; Middle Aged; Prostatic Hyperplasia; Ureteral Obstruction; Urinary Retention; Urinary Tract Infections
PubMed: 30277739
DOI: No ID Found -
Anesthesiology May 2009Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the... (Review)
Review
Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention (POUR). The authors review the overall incidence and mechanisms of POUR associated with surgery, anesthesia and analgesia. Ultrasound has been shown to provide an accurate assessment of urinary bladder volume and a guide to the management of POUR. Recommendations for urinary catheterization in the perioperative setting vary widely, influenced by many factors, including surgical factors, type of anesthesia, comorbidities, local policies, and personal preferences. Inappropriate management of POUR may be responsible for bladder overdistension, urinary tract infection, and catheter-related complications. An evidence-based approach to prevention and management of POUR during the perioperative period is proposed.
Topics: Anesthetics; Humans; Perioperative Care; Postoperative Complications; Risk Factors; Urinary Catheterization; Urinary Retention
PubMed: 19352147
DOI: 10.1097/ALN.0b013e31819f7aea -
American Family Physician Mar 2008Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as... (Review)
Review
Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alphaadrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.
Topics: Adult; Diagnostic Techniques, Urological; Female; Humans; Male; Severity of Illness Index; Treatment Outcome; Urinary Catheterization; Urinary Retention
PubMed: 18350762
DOI: No ID Found -
Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature.International Urogynecology Journal Jun 2022Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed.
METHODS
In our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed.
RESULTS
Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR.
CONCLUSIONS
In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.
Topics: Delivery, Obstetric; Female; Humans; Intermittent Urethral Catheterization; Postpartum Period; Pregnancy; Puerperal Disorders; Urinary Retention
PubMed: 35129645
DOI: 10.1007/s00192-021-05074-5 -
Current Urology Reports Aug 2019The purpose of this review is to summarize the role and significance of inflammation as a putative additional factor contributing to lower urinary tract symptoms and the... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize the role and significance of inflammation as a putative additional factor contributing to lower urinary tract symptoms and the progression of benign prostatic hyperplasia. We review (1) the histologic definition of prostatic inflammation and its prevalence, (2) the effects inflammation in the prostate including on risk of acute urinary retention, and (3) the effects of systemic inflammation on the prostate and on voiding.
RECENT FINDINGS
Inflammation is a highly prevalent finding in the prostate, both on a histological and biochemical level. Men with inflammation have higher IPSS scores and increased prostate size; however, these differences appear to be imperceptibly small. Men with inflammation do experience a significantly increased risk of developing acute urinary retention, an event that is associated with significant morbidity. Recently, attempts have been made to identify more specific biochemical markers of local inflammation, and to identify regional patterns of inflamed tissue within the prostate which may be associated with higher IPSS scores, accelerated progression, and AUR. The effects of systemic inflammatory states, most notably MetS, and their role in LUTS have also been examined. Inflammation is a common finding in prostates of aging men, but its contribution to lower urinary tract symptoms and benign prostatic hyperplasia progression appears to be small when considered as a clinically relevant entity. Advances in the understanding of different forms of inflammation, and their impact when experienced in different locations within the prostate, may refine this knowledge. Systemic inflammation affects voiding, including in the absence of a prostate, but again significant effects of systemic inflammation on the prostate itself are also difficult to demonstrate. Prostatic inflammation is associated with a significantly increased risk of acute urinary retention.
Topics: Acute Disease; Disease Progression; Humans; Inflammation; Lower Urinary Tract Symptoms; Male; Prostatic Hyperplasia; Prostatitis; Urinary Retention
PubMed: 31377881
DOI: 10.1007/s11934-019-0917-1 -
JAMA Network Open May 2022Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited.
OBJECTIVE
To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population.
INTERVENTIONS
Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery.
MAIN OUTCOMES AND MEASURES
The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight).
RESULTS
Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups.
CONCLUSIONS AND RELEVANCE
Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.
Topics: Acupuncture Points; Adult; Delivery, Obstetric; Female; Humans; Infant, Newborn; Pain; Postpartum Period; Pregnancy; Urinary Retention; Young Adult
PubMed: 35604687
DOI: 10.1001/jamanetworkopen.2022.13261 -
The Primary Care Companion For CNS... Feb 2021
Topics: Humans; Selective Serotonin Reuptake Inhibitors; Urinary Retention; Venlafaxine Hydrochloride
PubMed: 34000145
DOI: 10.4088/PCC.20l02702 -
European Journal of Gastroenterology &... Jan 2022
Topics: Constipation; Humans; Urinary Retention
PubMed: 33273268
DOI: 10.1097/MEG.0000000000001970 -
Ugeskrift For Laeger Apr 2024A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an... (Review)
Review
A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an overview of this examination modality. The objective is to rapidly address predefined dichotomised questions about the presence of an abdominal aortic aneurysm, gallstones, cholecystitis, hydronephrosis, urinary retention, free intraperitoneal fluid, and small bowel obstruction. FAUS is a valuable tool for emergency physicians to promptly confirm various conditions upon the patients' arrival, thus reducing the time to diagnosis and in some cases eliminating the need for other imaging.
Topics: Humans; Ultrasonography; Aortic Aneurysm, Abdominal; Hydronephrosis; Abdomen; Gallstones; Cholecystitis; Intestinal Obstruction; Urinary Retention; Point-of-Care Systems
PubMed: 38704706
DOI: 10.61409/V10230649