Morbidity and the impact on daily activities associated with catheter drainage after acute urinary retention

Abstract

Objective To evaluate the effect on quality of life of being discharged home with a catheter before de®nitive treatment in patients with acute urinary retention (AUR). Patients and methods Patients attending the emergency department with AUR were assessed and discharged home with a catheter if they ful®lled predetermined criteria. They were admitted to the day-care unit for urological assessment and completed a disease-speci®c quality-of-life questionnaire. Results Of 101 patients presenting to the emergency department in AUR, 84 were sent home after catheterization (83%); 78 (93%) patients completed the questionnaire. The major side-effects reported were urinary leak (46%), mild haematuria (44%), urgency (42%), pain around the penis (42%), painful erection (31%) and catheter blockage (26%). Only 12% of patients felt having a catheter was very inconvenient and 93% would ®nd it acceptable to have a catheter in future. Conclusion A signi®cant minority of patients discharged home with a catheter had side-effects related to their catheter but were not greatly inconvenienced, and their capacity to carry out normal daily activities was not impaired. The immediate discharge of patients in AUR and planned treatment will enable better use of inpatient urology resources. Keywords Acute urinary retention, catheterization, quality of life IntroductionAcute urinary retention (AUR) is a common urological emergency and frequently results in TURP. The National Prostatectomy Audit (NPA) reported that 23% of all patients underwent TURP for this condition [1]. A subgroup analysis examined this patient population, particularly in relation to the practice of immediate discharge from hospital with a catheter compared with admission for investigation and treatment [2]. Of such patients, 52% were discharged immediately and 48% were admitted, highlighting the lack of consensus on whether it is safe or appropriate to discharge patients directly from the emergency department. The NPA con®rmed that the overall morbidity of these two patient groups was similar after TURP, except for an increased rate of urinary infection in those with prolonged catheterization. A reduction in the length of hospital stay bene®ts both the patient and the hospital, with potential cost savings. However, this has to be weighed against the potential morbidity and adverse impact on daily activities of having to manage a catheter at home. It has been the practice in our department, within established guidelines, to discharge patients from casualty after catheterization. This prospective study addressed the disease-speci®c quality of life of these patients to assess whether this is acceptable practice. Patients and methodsData were obtained prospectively over a 13-month period on all patients presenting with their ®rst episode of AUR. Criteria for immediate discharge were established and approved. These included normal renal function, absence of macroscopic haematuria and/or clot retention, lack of concomitant medical condition warranting hospital admission, and ade...

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

“…In a UK survey, 65.5% of physicians automatically admitted men catheterized for AUR whereas 19.3% would only admit those with renal impairment [10]. According to the UK National Prostatectomy Audit, men discharged home after catheterization to await surgery showed a higher rate of uncomplicated urinary tract infection and consequently received more antibiotics than those kept in hospital but there was no increased risk of major infective complications [15,16]. Nevertheless, cost savings of sending the patient home should be balanced against patient discomfort and anxiety generated by the catheter being in situ outside the hospital.…”

Comparison of men with acute versus chronic urinary retention: aetiology, clinical features and complications

“…2 In a study from England, the mean period of catheterisation was 23 days, and only 12% of patients felt a catheter was very inconvenient. 26 The Reten-World survey showed that the risk of catheter-related complications is related to the duration of catheterisation, with a significantly higher incidence of haematuria, infection, urine leak and catheter obstruction associated with catheterisation lasting longer than three days. 27 In the present study, the mean and median time between catheterisation for retention and surgery were 94.5 and 52.5 days respectively.…”

Efficacy of Doxazosin in the Treatment of Acute Urinary Retention due to Benign Prostate Hyperplasia

“…AUR conditions prostatectomy in 24-42% of males in the UK and the USA [18] . The National Prostatectomy Audit (NPA) published that 23% of all patients undergoing transurethral resection of the prostate gland were subjected to this operation because of this situation [19] . These percentages agree with the results of our own series, where 32.6% of patients continue with spontaneous micturition.…”