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Acute urinary retention in men: The risks and outcomes with medical therapy

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Current Prostate Reports

Abstract

This paper is restricted to the discussion of the relatively modern disorder of sudden painful inability to urinate in older men. It was not a common medical problem until the 19th century when, in developed countries, male life expectancy increased to beyond 60 years; it remains an uncommon problem in those developing countries where male life expectancy remains low, particularly in some sub-Saharan African countries where male life expectancy is only 44.8 years.

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References and Recommended Reading

  1. Glynn RJ, Campion EW, Bouchard GR, et al.: The development of benign prostatic hyperplasia among volunteers in the Normative Aging Study. Am J Epidemiol 1985, 121:78. The importance of this study is that it provides information about the natural history of prostatic hyperplasia at a time when medical treatment was not widely used. Because of the widespread use of 5-α reductase inhibitors and α-blockers, it would be difficult or impossible to reproduce this dataset today.

    PubMed  CAS  Google Scholar 

  2. Hargreave TB, Botto H, Rikken GH, et al.: European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate Eur Urol 1993, 23:437–443.

    PubMed  CAS  Google Scholar 

  3. Robinson MR, Cross RJ, Shetty MB, Fittall B: Bacteriaemia and bacteriogenic shock in district hospital urological practice. Br J Urol 1980, 52:10–14.

    Article  PubMed  CAS  Google Scholar 

  4. Murphy DM, Falkiner FR, Carr M, et al.: Septicemia after transurethral prostatectomy. Urology 1983, 22:133–135.

    Article  PubMed  CAS  Google Scholar 

  5. Pickard R, Emberton M, Neal DE: The management of men with acute urinary retention. National Prostatectomy Audit Steering Group. Br J Urol 1998, 81:712–720. The importance of this study is that it was a properly funded audit of prostate surgery from regions in the UK and included large numbers of men; the results thus reflect the standard of care in a situation in which most of the population attends one health care provider—the UK National Health Service.

    Article  PubMed  CAS  Google Scholar 

  6. McNeill SA, Hargreave TB: Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention. J Urol 2004, 171:2316–2320. The importance of this study is that it has adequate power because of larger numbers. This is very difficult to achieve in the context of emergency treatment because of the variety of different practitioners and hospitals that deal with AUR.

    Article  PubMed  CAS  Google Scholar 

  7. Warren JW, Tenney JH, Hoopes JM, et al.: A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982, 146:719–723.

    Article  PubMed  CAS  Google Scholar 

  8. Warren JW: Nosocomial urinary tract infections. In Principles and Practice of Infectious Diseases, edn 4. Edited by Mandell GL, Bennett JE, Dolin R. New York: Churchill Livingstone; 1995:2607–2616.

    Google Scholar 

  9. Grabe M, Forsgren A, Hellsten S: The effect of a short antibiotic course in transurethral prostatic resection. Scand J Urol Nephrol 1984, 18:37–42.

    Article  PubMed  CAS  Google Scholar 

  10. Cafferkey MT, Conneely B, Falkiner FR, et al.: Postoperative urinary infection and septicaemia in urology. J Hosp Infect 1980, 1:315–320.

    Article  PubMed  CAS  Google Scholar 

  11. Khoubehi B, Watkin NA, Mee AD, Ogden CW: Morbidity and the impact on daily activities associated with catheter drainage after acute urinary retention. BJU Int 2000, 85:1033–1036.

    Article  PubMed  CAS  Google Scholar 

  12. Mustonen S, Ala-Houhala IO, Tammela TL: Long-term renal dysfunction in patients with acute urinary retention. Scand J Urol Nephrol 2001, 35:44–48.

    PubMed  CAS  Google Scholar 

  13. Roehrborn CG, Malice M, Cook TJ, Girman CJ: Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urology 2001, 58:210–216. This pooled analysis is important because of the large numbers of men included, thus reducing bias.

    Article  PubMed  CAS  Google Scholar 

  14. Chan JE, Kapoor A: Herpes zoster infection: a rare cause of acute urinary retention. Can J Urol 2003, 10:1912–1913.

    PubMed  Google Scholar 

  15. Acheson J, Mudd D: Acute urinary retention attributable to sacral herpes zoster. Emerg Med J 2004, 21:752–753.

    Article  PubMed  CAS  Google Scholar 

  16. Holm NR, Horn T, Smedts F, et al.: Does ultrastructural morphology of human detrusor smooth muscle cells characterize acute urinary retention? J Urol 2002, 167:1705–1709.

    Article  PubMed  Google Scholar 

  17. Hubly JW, Thompson GJ: Infarction of the prostate and volumetric changes produced by the lesion. J Urol 1940, 43:459.

    Google Scholar 

  18. Spiro LH, Labay G, Orkin LA: Prostatic infarction: role in acute urinary retention. Urology 1974, 3:345–347.

    Article  PubMed  CAS  Google Scholar 

  19. Anjum I, Ahmed M, Azzopardi A, Mufti GR: Prostatic infarction/infection in acute urinary retention secondary to benign prostatic hyperplasia. J Urol 1998, 160:792–793.

    Article  PubMed  CAS  Google Scholar 

  20. Hargreave TB, Stephenson TP: Potency and prostatectomy. BrJ Urol 1977, 19:683–688. Perhaps one of the earliest studies addressing sexual function and prostatectomy.

    Article  Google Scholar 

  21. Shimomura T, Kiyota H, Takahashi H, et al.: [Prostate histopathology of NIH category IV prostatitis detected by sextant prostate needle biopsy from the patients with high prostatic specific antigen]. Kansenshogaku Zasshi 2003, 77:611–617.

    PubMed  Google Scholar 

  22. Canfield PJ: A survey of koala road kills in New South Wales. J WildlDis 1991, 27:657–660.

    CAS  Google Scholar 

  23. Moron G, Maletto B, Ropolo A, Pistoresi-Palencia MC: Changes in the development of experimental autoimmune prostatitis (EAP) by castration in aged rats. Dev Comp Immunol 2000, 24:673–682.

    Article  PubMed  CAS  Google Scholar 

  24. Naslund MJ, Strandberg JD, Coffey DS: The role of androgens and estrogens in the pathogenesis of experimental nonbacterial prostatitis. J Urol 1988, 140:1049–1053.

    PubMed  CAS  Google Scholar 

  25. Garraway WM, Collins GN, Lee RJ: High prevalence of benign prostatic hypertrophy in the community. Lancet 1991, 338:469–471.

    Article  PubMed  CAS  Google Scholar 

  26. Jacobsen SJ, Jacobson DJ, Girman CJ, et al.: Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997, 158:481–487.

    Article  PubMed  CAS  Google Scholar 

  27. Meigs JB, Barry MJ, Giovannucci E, et al.: Incidence rates and risk factors for acute urinary retention: the health professionals follow-up study. J Urol 1999, 162:376–382.

    Article  PubMed  CAS  Google Scholar 

  28. Murray K, Massey A, Feneley RC: Acute urinary retention: a urodynamic assessment. Br J Urol 1984, 6:468–473.

    Google Scholar 

  29. McNeill AS, Rizvi S, Byrne DJ: Prostate size influences the outcome after presenting with acute urinary retention. BJU Int 2004, 94:559–562.

    Article  PubMed  Google Scholar 

  30. Kolman C, Girman CJ, Jacobsen SJ, et al.: Distribution of postvoid residual urine volume in randomly selected men. J Urol 1999, 161:122–127.

    Article  PubMed  CAS  Google Scholar 

  31. Marberger MJ, Andersen JT, Nickel JC, et al.: Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention: combined experience from three large, multinational, placebo-controlled trials. Eur Urol 2000, 38:563–568.

    Article  PubMed  CAS  Google Scholar 

  32. Roehrborn CG, Bruskewitz R, Nickel GC, et al.: Urinary retention in patients with BPH treated with finasteride or placebo over 4 years: characterization of patients and ultimate outcomes. PLESS Study Group. Eur Urol 2000, 37:528–536.

    Article  PubMed  CAS  Google Scholar 

  33. Dubey D, Kumar A, Kapoor R, et al.: Acute urinary retention: defining the need and timing for pressure-flow studies. BJU Int 2001, 88:178–182.

    Article  PubMed  CAS  Google Scholar 

  34. Miyashita H, Kojima M, Miki T: 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. Ultrasound Med Biol 2002, 28:985–990.

    Article  PubMed  Google Scholar 

  35. McConnell JD, Roehrborn CG, Bautista OM, et al.: The longterm effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003, 349:2387–2398.

    Article  PubMed  CAS  Google Scholar 

  36. McNeill SA, Hargreave TB, Geffriaud-Ricouard C, et al.: Postvoid residual urine in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: pooled analysis of eleven controlled studies with alfuzosin. Urology 2001, 57:459–465.

    Article  PubMed  CAS  Google Scholar 

  37. McConnell JD, Bruskewitz R, Walsh P, et al.: The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998, 338:557–563.

    Article  PubMed  CAS  Google Scholar 

  38. Roehrborn CG, Bruskewitz R, Nickel JC, et al.: Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia. J Urol 2004, 171:1194–1198.

    Article  PubMed  Google Scholar 

  39. Roehrborn CG, Boyle P, Nickel JC, et al.: Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002, 60:434–441.

    Article  PubMed  Google Scholar 

  40. Andriole GL, Humphrey P, Ray P, et al.: Effect of the dual 5alpha-reductase inhibitor dutasteride on markers of tumor regression in prostate cancer. J Urol 2004, 172:915–919. This is likely to be an important study because it benefits from some of the conundrums caused by the Prostate Cancer Prevention Trial finasteride data. If it can be clearly established that long-term 5α-reductase treatment is safe and even beneficial in terms of cancer risk, then medical treatment for lower urinary tract symptoms will become the treatment of choice for most men.

    Article  PubMed  CAS  Google Scholar 

  41. Debruyne FM, Van der Poel HG: Clinical experience in Europe with uroselective al-antagonists. Eur Urol 1999, 36(suppl l):54–58.

    Article  PubMed  CAS  Google Scholar 

  42. Roehrborn CG: Alfuzosin: overview of pharmacokinetics, safety, and efficacy of a clinically uroselective alpha-blocker. Urology 2001, 58(suppl 6A):55–63.

    Article  PubMed  CAS  Google Scholar 

  43. Chan PS, Wong WS, Chan LW, et al.: Can terazosin (alpha-blocker) relieve acute urinary retention and obviate the need for indwelling urethral catheter [Abstract 26]? BrJ Urol 1996, 77(suppl 1):7.

    Google Scholar 

  44. McNeill SA, Daruwala PD, Mitchell ID, et al.: Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled trial. BJU Int 1999, 84:622–627.

    Article  PubMed  CAS  Google Scholar 

  45. Bowden E, Hall S, Foley SJ, et al.: Tamsulosin in the treatment of urinary retention: a prospective, placebo-controlled trial [Abstract P148]. BJU Int 2001, 88:77.

    Article  Google Scholar 

  46. Abeygunasekera AM, de Silva S, Gurusingha A, Wijeratne S: Management of men with a first episode of acute urinary retention due to benign prostatic enlargement. Ceylon Med J 2001,46:124–125.

    PubMed  CAS  Google Scholar 

  47. Kim HL, Kim JC, Benson DA, et al.: Results of treatment with tamsulosin in men with acute urinary retention. Tech Urol 2001, 7:256–260.

    PubMed  CAS  Google Scholar 

  48. Lucas M, Stephenson T, Vinod N: Tamsulosin in the management of patients in acute urinary retention due to benign prostatic hyperplasia. Eur Urol 2002, 1:106.

    Google Scholar 

  49. Shah T, Palit V, Biyani S, et al.: Randomised, placebo-controlled, double-blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention. Eur Urol 2002, 42:329–332.

    Article  PubMed  CAS  Google Scholar 

  50. Kaplan SA: A prospective study of conservatively managed acute urinary retention: prostate size matters. J Urol 2002, 168:402.

    Google Scholar 

  51. Hua LX, Wu HF, Sui YG, et al.: [Tamsulosin in the treatment of benign prostatic hyperplasia patients with acute urinary retention]. Zhonghua Nan Ke Xue 2003, 9:510–511.

    PubMed  Google Scholar 

  52. Lorente Garin JA, Canis Sanchez D, Arango Toro O, et al.: [Doxazosin in the gastrointestinal therapeutic system (GITS) formulation and trial without catheter after acute urinary retention due to BPH. Dose increase action on recovery effect]. Actas Urol Esp 2004, 28:32–37.

    Article  Google Scholar 

  53. Roehrborn C, Hargreave TB, McNeill SA, et al.: Influence of age on outcome of trial without catheter (TWOC) during alfuzosin 10 mg OD therapy in patients with acute urinary retention (AUR) related to BPH [Abstract 1366]. ALFAUR Study Group. J Urol 2004, 171(suppl):360.

    Google Scholar 

  54. Tan YH, Foo KT: Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urine retention. J Urol 2003, 170:2339–2341.

    Article  PubMed  Google Scholar 

  55. Klarskov P, Andersen JT, Asmussen CF, et al.: Symptoms and signs predictive of the voiding pattern after acute urinary retention in men. Scand J Urol Nephrol 1987, 21:23–28.

    Article  PubMed  CAS  Google Scholar 

  56. McNeill SA: Does acute urinary retention respond to alpha-blockers alone? Eur Urol 2001, 39(suppl 6):7–12.

    Article  PubMed  CAS  Google Scholar 

  57. McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group: Alfuzosin 10 mg once a day in the management of acute urinary retention: results of a double blind, placebo-controlled study. Urology 2005, 65:83–90.

    Article  PubMed  CAS  Google Scholar 

  58. Thompson IM, Goodman PJ, Tangen CM: The influence of finasteride on the development of prostate cancer. N Engl J Med 2003, 349:215–224.

    Article  PubMed  CAS  Google Scholar 

  59. Andriole G, Bostwick D, Brawley O, et al.: Chemoprevention of prostate cancer in men at high risk: rationale and design of the reduction by dutasteride of prostate cancer events (REDUCE) trial. J Urol 2004, 172:1314–1317.

    Article  PubMed  CAS  Google Scholar 

  60. Caine M, Pfau A, Perlberg S: The use of alpha-adrenergic blockers in benign prostatic obstruction. Br J Urol 1976, 48:255–263.

    PubMed  CAS  Google Scholar 

  61. Breum L, Klarskov P, Munck LK, et al.: Significance of acute urinary retention due to intravesical obstruction. Scand J Urol Nephrol 1982, 16:21–24.

    Article  PubMed  CAS  Google Scholar 

  62. Craigen AA, Hickling JB, Saunders CR, et al.: Natural history of prostatic obstruction: a prospective survey. J R Coll Gen Pract 1969, 18:226–232.

    PubMed  CAS  Google Scholar 

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Hargreave, T.B., McNeill, A.S. Acute urinary retention in men: The risks and outcomes with medical therapy. Curr prostate rep 3, 121–128 (2005). https://doi.org/10.1007/s11918-005-0004-6

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