Chronic urinary retention in men: How we define it, and how does it affect treatment outcome

Abstract

What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced‐based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced‐based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: ‘urinary retention’, ‘chronic urinary retention’ and ‘PVR’. Chronic urinary retention (CUR) is defined by the International Continence Society as ‘a non‐painful bladder, which remains palpable or percussable after the patient has passed urine’. Abrams was the first to choose a residual urine volume >300 mL to define CUR as he considered it the minimum volume at which the bladder becomes palpable suprapubically. The UK National Institute for Health and Clinical Excellence lower urinary tract symptoms (LUTS) guidelines define CUR as a postvoid residual urine volume (PVR) of >1000 mL. No studies have specifically addressed the problem of quantifying the minimum amount of urine present in the bladder to define CUR. Nor did we find any publications objectively assessing at what amount of urine a bladder can be palpable. The ability to feel a bladder may rely on variables (i.e. medical skills and patient habitus). There is a marked variability of PVR, so the test should be repeated to improve precision. As defining CUR is difficult, structured management is challenging. Nearly all prospective trials exclude m...

Acute and chronic urine retention among adults at the urology section of the Accident and Emergency Unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana

“…In the present study, the prevalence of AUR was found to be 83.5%, while CUR accounted for 16.5%. In view of the lack of an international consensus on the definition of CUR, most prospective studies excluded patients with CUR because of the difficulty associated with the design of the study and the interpretation of results, and the possibility of associated complications and the anticipation of an adverse outcome [19].…”

Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention

“…CUR remains poorly described in the literature, with definitions consisting of variable post-void residual urine volumes (PVRs) ranging from >300 to >1000 mL or an asymptomatic palpable bladder after voiding [11][12][13]. Regardless, the possible effects of CUR include nocturnal incontinence, risk of UTIs, bladder calculi, and renal dysfunction.…”

Drug-Induced Acute Urinary Retention #287

“…Common symptoms of chronic urinary retention include frequency, hesitancy, and decreased force of urine stream. 3 This article pertains to acute urinary retention due to medications.…”