Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a non-urological population clinical study of the relationship between lower limbs and bladder function

Abstract

ObjectivesTo understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters.Materials and Methods56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used.ResultsAll patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up.ConclusionsRecovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

Pelvic Floor Considerations in COVID-19

“…Recovery from urinary retention directly correlates with the recovery of lower-limb function after PICS, so this concept could be an important measurement for physical therapists to keep in mind when treating this patient population. 35 …”

Why upright standing men urinate more efficiently than in supine position: A morphological analysis with real‐time magnetic resonance imaging

“…Maintenance of an upright body posture, either when sitting or standing, may contribute to smooth micturition in males. Additionally, these results may also explain, at least in part, why a decline in ADL is associated with dysuria, typically seen in elderly patients who have undergone invasive surgery or are in a period of long‐term bedrest 2,3 . Another important point is that relaxation movement of the pelvic floor muscle is more difficult in supine position.…”

“…Additionally, these results may also explain, at least in part, why a decline in ADL is associated with dysuria, typically seen in elderly patients who have undergone invasive surgery or are in a period of long-term bedrest. 2,3 Another important point is that relaxation movement of the pelvic floor muscle is more difficult in supine position. This would be a scientific basis for assisting patients to move to toilet when they have difficulty to urinate in lying position, after invasive surgery or prolonged bedrest.…”

“…Among mammals, only human males have evolved to have the capability to urinate in bipedal sitting and standing positions 1 . Dysuria frequently occurs in both males and females with impaired activities of daily living (ADL), especially in those who must urinate while in a resting position after invasive surgery or in confinement to bedrest for a long period 2,3 . Yamanishi et al 4 reported that supine position urination had a lower flow rate as compared with that in a standing or sitting position.…”