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Acute urinary retention: Who is at risk and how best to manage it?

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Abstract

In recent years, we have begun to understand the progressive nature of benign prostatic hyperplasia. By careful analysis of population studies and clinical trials, we can determine the factors most likely to predict progression to one of its most distressing complications, acute urinary retention. Acute urinary retention is a common urologic emergency and causes significant suffering, although rarely has it any serious consequences. Using our knowledge regarding the progression of benign prostatic hyperplasia, new treatment modalities are being assessed for their effectiveness at halting progression and ultimately preventing this distressing condition.

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References and Recommended Reading

  1. Choong S, Emberton M: Acute urinary retention. BJU Int 2000, 85:186–201.

    Article  PubMed  CAS  Google Scholar 

  2. Hargreave TB, McNeill AS: Acute urinary retention in men: the risks and outcomes with medical therapy. Curr Prostate Rep 2005, 3:121–128.

    Article  Google Scholar 

  3. Thomas K, Chow K, Kirby RS: Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis 2004, 7:32–37.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  5. Lepor H: Managing and preventing acute urinary retention. Rev Urol 2005, 7(suppl 8):26–33.

    Google Scholar 

  6. 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 

  7. Roehrborn C: Acute urinary retention: risks and management. Rev Urol 2005, 7(suppl 4):31–41.

    Google Scholar 

  8. Crawford ED: Management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the central role of the patient risk profile. BJU Int 2005, 95(suppl 4):1–5.

    Article  PubMed  Google Scholar 

  9. Kim ED: The use of baseline clinical measures to predict those at risk for progression of benign prostatic hyperplasia. Curr Urol Rep 2004, 5:267–273.

    Article  PubMed  Google Scholar 

  10. Jimenez-Cruz F: Identifying patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/ BPH) at risk for progression. Eur Urol Suppl 2003, 2:6–12.

    Article  Google Scholar 

  11. Jacobsen SJ, Girman CJ, Lieber MM: Natural history of benign prostatic hyperplasia. Urology 2001, 58(suppl 6A):5–16. First description that surrogate markers have predictive validity for hard outcomes such as AUR and the need for surgery.

    Article  PubMed  CAS  Google Scholar 

  12. Djavan B, Fong YK, Harik M, et al.: Longitudinal study of men with mild symptoms of bladder outlet obstruction treated with watchful waiting for four years. Urology 2004, 64:1144–1148.

    Article  PubMed  Google Scholar 

  13. Ball AJ, Feneley RC, Abrams PH: The natural history of untreated “prostatism”. Br J Urol 1981, 53:613–616.

    PubMed  CAS  Google Scholar 

  14. Birkhoff JD, Wiederhorn AR, Hamilton ML, Zinsser HH:Natural history of benign prostatic hypertrophy and acute urinary retention. Urology 1976, 7:48–52.

    Article  PubMed  CAS  Google Scholar 

  15. Wasson JH, Reda DJ, Bruskewitz RC, et al.: A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995, 332:75–79.

    Article  PubMed  CAS  Google Scholar 

  16. Barry MJ, Fowler FJ Jr, Bin L, et al.: The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol 1997, 157:10–15.

    Article  PubMed  CAS  Google Scholar 

  17. 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 

  18. Jacobsen SJ, Jacobson DJ, Girman CJ, et al.: Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997, 158:481–487. Observational study of men from Olmsted County that provided much newer data regarding BPH progression in addition to risk factors associated with AUR.

    Article  PubMed  CAS  Google Scholar 

  19. Kirby RS: The natural history of benign prostatic hyperplasia: What have we learned in the last decade? Urology 2000, 56(suppl 5A):3–6.

    Article  PubMed  CAS  Google Scholar 

  20. Kurita Y, Masuda H, Terada H, et al.: Transition zone index as a risk factor for acute urinary retention in benign prostatic hyperplasia. Urology 1998, 51:595–600.

    Article  PubMed  CAS  Google Scholar 

  21. Verhamme KM, Dieleman JP, van Wijk MA, et al.: Low incidence of acute urinary retention in the general male population: the triumph project. Eur Urol 2005, 47:494–498.

    Article  PubMed  CAS  Google Scholar 

  22. Trachtenberg J: Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in relation to the patient’s risk profile for progression. BJU Int 2005, 95(suppl 4):6–11.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

  24. Roehrborn CG, McConnell J, Bonilla J, et al.: Serum prostate-specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term Efficacy and safety study. J Urol 2000, 163:13–20.

    Article  PubMed  CAS  Google Scholar 

  25. Roehrborn CG, McConnell JD, Lieber M, et al.: Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999, 53:473–480.

    Article  PubMed  CAS  Google Scholar 

  26. Bosch JL, Bohnen AM, Groeneveld FP: Validity of digital rectal examination and serum prostate specific antigen in the estimation of prostate volume in communitybased men aged 50 to 78 years: the Krimpen Study. Eur Urol 2004, 46:753–759.

    Article  PubMed  CAS  Google Scholar 

  27. McConnell JD, Roehrborn CG, Bautista OM, et al.: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003, 349:2387–2398. Seminal paper in the field. Measured Efficacy of treatment in terms of BPH progression, included AUR as an endpoint. First trial to show a clear benefit with long-term combination therapy.

    Article  PubMed  CAS  Google Scholar 

  28. Lepor H, Williford WO, Barry MJ, et al.: The Efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 1996, 335:533–539.

    Article  PubMed  CAS  Google Scholar 

  29. Kirby RS, Roehrborn C, Boyle P, et al.: Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 2003, 61:119–126.

    Article  PubMed  Google Scholar 

  30. 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 

  31. Andersen JT, Nickel JC, Marshall VR, et al.: Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia. Urology 1997, 49:839–845.

    Article  PubMed  CAS  Google Scholar 

  32. 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 

  33. 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 

  34. Roehrborn CG: Reporting of acute urinary retention in BPH treatment trials: importance of patient follow-up after discontinuation and case definitions. Urology 2002, 59:811–815.

    Article  PubMed  Google Scholar 

  35. Boyle P, Roehrborn C, Harkaway R, et al.: 5-Alpha reductase inhibition provides superior benefits to alpha blockade by preventing AUR and BPH-related surgery. Eur Urol 2004, 45:620–627.

    Article  PubMed  CAS  Google Scholar 

  36. Logie JW, Clifford GM, Farmer RD, Meesen BP: Lower urinary tract symptoms suggestive of benign prostatic obstruction--Triumph: the role of general practice databases. Eur Urol 2001, 39(suppl 3):42–47.

    Article  PubMed  CAS  Google Scholar 

  37. Clifford GM, Logie J, Farmer RD: How do symptoms indicative of BPH progress in real life practice? The UK experience. Eur Urol 2000, 38(suppl 1):48–53.

    Article  PubMed  Google Scholar 

  38. Artibani W: Integrating the patient risk profile in the management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Eur Urol Suppl 2004, 3:1–6.

    Article  Google Scholar 

  39. Chapple CR: The total approach in lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) management: introduction and conclusions. Eur Urol Suppl 2003, 2:1–5.

    Article  Google Scholar 

  40. Lowe FC: Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: sexual function. BJU Int 2005, 95(suppl 4):12–18.

    Article  PubMed  CAS  Google Scholar 

  41. Barendrecht MM, Koopmans RP, de la Rosette JJ, Michel MC: Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system. BJU Int 2005, 95(suppl 4):19–28.

    Article  PubMed  CAS  Google Scholar 

  42. Horgan AF, Prasad B, Waldron DJ, O’Sullivan DC: Acute urinary retention. Comparison of suprapubic and urethral catheterization. Br J Urol 1992, 70:149–151.

    Article  PubMed  CAS  Google Scholar 

  43. 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.

    PubMed  CAS  Google Scholar 

  44. Kumar V, Marr C, Bhuvangiri A, Irwin P: A prospective study of conservatively managed acute urinary retention: prostate size matters. BJU Int 2000, 86:816–819.

    Article  PubMed  CAS  Google Scholar 

  45. McNeill SA, Hargreave TB: Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention. J Urol 2004, 171:2316–2320.

    Article  PubMed  CAS  Google Scholar 

  46. McNeill SA, Hargreave TB, Roehrborn CG: Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind, placebo-controlled study. Urology 2005, 65:83–90. Large, well-designed dual RCT to assess the success of TWOC with alfuzosin and to determine if continued treatment prevents AUR relapse or need for surgery.

    Article  PubMed  CAS  Google Scholar 

  47. Annemans L, Cleemput I, Lamotte M, et al.: The economic impact of using alfuzosin 10 mg once daily in the management of acute urinary retention in the UK: a 6-month analysis. BJU Int 2005, 96:566–571.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  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. Lucas MG, Stephenson TP, Nargund V: Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int 2005, 95:354–357. Recent RCT that has confirmed the class effect of á-antagonists promoting successful outcome after TWOC.

    Article  PubMed  CAS  Google Scholar 

  51. 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 

  52. Manikandan R, Srirangam SJ, O’Reilly PH, Collins GN:Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey. BJU Int 2004, 93:84–88.

    Article  PubMed  CAS  Google Scholar 

  53. 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 

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Correspondence to Christopher Chapple BSc, MD.

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Patel, A., Chapple, C. Acute urinary retention: Who is at risk and how best to manage it?. Curr Urol Rep 7, 252–259 (2006). https://doi.org/10.1007/s11934-996-0003-3

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