Advertisement

Current Urology Reports

, 18:74 | Cite as

Non-neurogenic Chronic Urinary Retention: What Are We Treating?

  • John T. StoffelEmail author
Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Abstract

Purpose of Review

This review examines current terminology used to define non-neurogenic chronic urinary retention (CUR), describes the pathophysiology of urinary retention, and highlights contemporary diagnostic and treatment algorithms.

Recent Findings

There is no standardized definition for the condition, but volumes >300 ml are commonly used to describe CUR. It is a clinical diagnosis which does not require urodynamics. Pathophysiologic causes of CUR be from myogenic, neurogenic, bladder outlet obstruction, or a combination of these sources. Treatment algorithms recommend stratifying patients with chronic urinary retention by risk and by symptoms before initiating treatment. Common CUR outcome endpoints need to be better utilized so that treatment modalities can be compared.

Summary

Non-neurogenic CUR is a heterogeneous condition that has multiple definitions, underlying physiologies, and possible endpoints. Standardization is needed to better understand and treat CUR.

Keywords

Urinary retention Bladder outlet obstruction Underactive bladder 

Notes

Compliance with Ethical Standards

Conflict of Interest

John Stoffel reports grants from PCORI and Uroplasty.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Abrams PH, Dunn M, George N. Urodynamic findings in chronic retention of urine and their relevance to results of surgery. Br Med J. 1978;2(6147):1258–60.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Negro CL, Muir GH. Chronic urinary retention in men: how we define it, and how does it affect treatment outcome. BJU Int. 2012;110(11):1590–4.CrossRefPubMedGoogle Scholar
  4. 4.
    •• Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA white paper: non-neurogenic chronic urinary retention: consensus definition, treatment algorithm, and outcome endpoints. J Urol 2017. AUA Quality Improvement and Patient Safety committee sponsored this white paper to create a standardized CUR definition, treatment algorithm, and treatment endpoints based on available evidence.Google Scholar
  5. 5.
    Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014;65(2):389–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol. 2013;15(1):11–22.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Jiang YH, Kuo HC. Video-urodynamic characteristics of non-neurogenic, idiopathic underactive bladder in men—a comparison of men with normal tracing and bladder outlet obstruction. PLoS One. 2017;12(4):e0174593.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84(1):14–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Schafer W. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol. 1995;13(1):47–58.CrossRefPubMedGoogle Scholar
  10. 10.
    Oelke M, Rademakers KL, van Koeveringe GA. Detrusor contraction power parameters (BCI and W max) rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis. World J Urol. 2014;32(5):1177–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Aldamanhori R, Chapple CR. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol. 2017;27(3):293–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Justo D, Schwartz N, Dvorkin E, Gringauz I, Groutz A. Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department: a prospective study. Neurourol Urodyn. 2017;36(3):794–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Cohn JA, Ni S, Kaufman MR, Graves AJ, Penson DF, Dmochowski RR, et al. Urinary retention and catheter use among U.S. female Medicare beneficiaries: prevalence and risk factors. Neurourol Urodyn 2017.Google Scholar
  14. 14.
    Aitken KJ, Bagli DJ. The bladder extracellular matrix. Part I: architecture, development and disease. Nat Rev Urol. 2009;6(11):596–611.CrossRefPubMedGoogle Scholar
  15. 15.
    Clemens JQ. Basic bladder neurophysiology. Urol Clin North Am. 2010;37(4):487–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Mansfield KJ, Liu L, Mitchelson FJ, Moore KH, Millard RJ, Burcher E. Muscarinic receptor subtypes in human bladder detrusor and mucosa, studied by radioligand binding and quantitative competitive RT-PCR: changes in ageing. Br J Pharmacol. 2005;144(8):1089–99.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Matsumoto Y, Miyazato M, Yokoyama H, Kita M, Hirao Y, Chancellor MB, et al. Role of M2 and M3 muscarinic acetylcholine receptor subtypes in activation of bladder afferent pathways in spinal cord injured rats. Urology. 2012;79(5):e15–20. 1184CrossRefGoogle Scholar
  18. 18.
    Hypolite JA, Malykhina AP. Regulation of urinary bladder function by protein kinase C in physiology and pathophysiology. BMC Urol. 2015;15:110.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Andersson KE, Arner A. Urinary bladder contraction and relaxation: physiology and pathophysiology. Physiol Rev. 2004;84(3):935–86.CrossRefPubMedGoogle Scholar
  20. 20.
    Ehrhardt A, Wang B, Yung AC, Wang Y, Kozlowski P, van Breemen C, et al. Urinary retention, incontinence, and dysregulation of muscarinic receptors in male mice lacking Mras. PLoS One. 2015;10(10):e0141493.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Iijima K, Igawa Y, Wyndaele JJ, De Wachter S. Mechanosensitive primary bladder afferent activity in rats with and without spinal cord transection. J Urol. 2009;182(5):2504–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Araki I, De Groat WC. Unitary excitatory synaptic currents in preganglionic neurons mediated by two distinct groups of interneurons in neonatal rat sacral parasympathetic nucleus. J Neurophysiol. 1996;76(1):215–26.PubMedGoogle Scholar
  24. 24.
    Burmeister D, Abou Shwareb T, D'Agostino R Jr, Andersson KE, Christ GJ. Impact of partial urethral obstruction on bladder function: time-dependent changes and functional correlates of altered expression of Ca(2)(+) signaling regulators. Am J Physiol Renal Physiol. 2012;302(12):F1517–28.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Zderic SA, Chacko S. Alterations in the contractile phenotype of the bladder: lessons for understanding physiological and pathological remodelling of smooth muscle. J Cell Mol Med. 2012;16(2):203–17.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Smith PP. Aging and the underactive detrusor: a failure of activity or activation? Neurourol Urodyn. 2010;29(3):408–12.PubMedGoogle Scholar
  27. 27.
    Kavia R, Dasgupta R, Critchley H, Fowler C, Griffiths D. A functional magnetic resonance imaging study of the effect of sacral neuromodulation on brain responses in women with Fowler’s syndrome. BJU Int. 2010;105(3):366–72.CrossRefPubMedGoogle Scholar
  28. 28.
    Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1):118–40.CrossRefPubMedGoogle Scholar
  29. 29.
    Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006;175(4):1422–6. discussion 6-7CrossRefPubMedGoogle Scholar
  30. 30.
    Yamasaki T, Naganuma T, Iguchi T, Kuroki Y, Kuwabara N, Takemoto Y, et al. Association between chronic kidney disease and small residual urine volumes in patients with benign prostatic hyperplasia. Nephrology (Carlton). 2011;16(3):335–9.CrossRefGoogle Scholar
  31. 31.
    Styles RA, Neal DE, Griffiths CJ, Ramsden PD. Long-term monitoring of bladder pressure in chronic retention of urine: the relationship between detrusor activity and upper tract dilatation. J Urol. 1988;140(2):330–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Comiter CV, Sullivan MP, Schacterle RS, Cohen LH, Valla SV. Urodynamic risk factors for renal dysfunction in men with obstructive and nonobstructive voiding dysfunction. J Urol. 1997;158(1):181–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Caron F, Alexandre K, Pestel-Caron M, Chassagne P, Grise P, Etienne M. High bacterial titers in urine are predictive of abnormal postvoid residual urine in patients with urinary tract infection. Diagn Microbiol Infect Dis. 2015;83(1):63–7.CrossRefPubMedGoogle Scholar
  34. 34.
    May M, Brookman-Amissah S, Hoschke B, Gilfrich C, Braun KP, Kendel F. Post-void residual urine as a predictor of urinary tract infection—is there a cutoff value in asymptomatic men? J Urol. 2009;181(6):2540–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Omli R, Skotnes LH, Mykletun A, Bakke AM, Kuhry E. Residual urine as a risk factor for lower urinary tract infection: a 1-year follow-up study in nursing homes. J Am Geriatr Soc. 2008;56(5):871–4.CrossRefPubMedGoogle Scholar
  36. 36.
    Douenias R, Rich M, Badlani G, Mazor D, Smith A. Predisposing factors in bladder calculi. Review of 100 cases. Urology. 1991;37(3):240–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Childs MA, Mynderse LA, Rangel LJ, Wilson TM, Lingeman JE, Krambeck AE. Pathogenesis of bladder calculi in the presence of urinary stasis. J Urol. 2013;189(4):1347–51.CrossRefPubMedGoogle Scholar
  38. 38.
    Morhardt DR, Cox L, Stoffel JT. Delivery of a massive urinary stone from an augmented bladder using obstetrical forceps. Can J Urol. 2015;22(1):7671–3.PubMedGoogle Scholar
  39. 39.
    Asimakopoulos AD, De Nunzio C, Kocjancic E, Tubaro A, Rosier PF, Finazzi-Agro E. Measurement of post-void residual urine. Neurourol Urodyn. 2016;35(1):55–7.CrossRefPubMedGoogle Scholar
  40. 40.
    • Kalejaiye O, Speakman MJ. Management of acute and chronic retention in men. Eur Urol. 2009;8(6):523–529. National Health System algorithm for treating CUR Google Scholar
  41. 41.
    •• Brasure M, Fink HA, Risk M, Mac Donald R, Shamliyan T, Ouellette J, et al. Chronic urinary retention: comparative effectiveness and harms of treatments. Rockville (MD): AHRQ Comparative Effectiveness Reviews; 2014. AHRQ literature review comparing effectiveness of CUR treatments. The heterogeneity in endpoints identified in this report lead to genesis of AUA publishing white paper on the subject Google Scholar
  42. 42.
    Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–57. discussion 64CrossRefPubMedGoogle Scholar
  43. 43.
    Averch TD SJ, Goldman HB, Griebling TL, Lerner L, Newman DK, Peterson AC. AUA white paper on catheter associated urinary tract infections: definitions and significance in the urological patient. Urology Practice. 2015; 2(6).Google Scholar
  44. 44.
    Mattiasson A, Wagrell L, Schelin S, Nordling J, Richthoff J, Magnusson B, et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2007;69(1):91–6. discussion 6-7CrossRefPubMedGoogle Scholar
  45. 45.
    •• Smith PP, Birder LA, Abrams P, Wein AJ, Chapple CR. Detrusor underactivity and the underactive bladder: symptoms, function, cause-what do we mean? ICI-RS think tank 2014. Neurourol Urodyn. 2016;35(2):312–7. Expert opinion conference on how to define and study underactive bladder CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of UrologyUniversity of MichiganAnn ArborUSA

Personalised recommendations