Journal Article w/ Summary

Article: Systematic Review and Meta-Analysis on Management of Acute Urinary Retention

ABSTRACT

BACKGROUND: Acute urinary retention (AUR) is a common urological emergency. In this article, we review the current literature and present a structured summary in management of AUR.
METHODS: A systematic review was conducted using the keywords ‘acute AND retention AND urin*’ within the title in search engines including Medline, EMBASE and EBM Review. The obtained literature was manually reviewed by the primary author (PDY) and was further refined by confining the subject to management of AUR. Exclusion criteria included pediatric and female population studies, case reports, reviews, surveys, economical assessment and articles on AUR in prostate cancer and post- operative patients.

RESULTS: Total of 54 articles met our inclusion and exclusion criteria. The trial without catheter (TWOC) post-immediate catheterization is widely practiced although there remains a significant variability in terms of type and duration of catheterization required, use of concurrent medical therapy or post-catheterization management. Our systematic review and subsequent meta-analysis has shown superiority of α1-adrenergic receptor blockers over placebo in achieving successful voiding in patients with AUR. Suprapubic catheter (SPC) is an alternative to urethral catheterization (indwelling catheter (IDC)) and may provide several advantages. Clean intermittent self-catheterization may be a safe and useful option for patients with AUR until their definitive management. The overall long-term outcome of in-and-out catheterization remains promising in selected patients. Surgery
is an end point in patients with unsuccessful TWOC as well as in those with significant lower urinary tract symptoms post-successful TWOC.
CONCLUSIONS: We recommend use of α1-adrenergic receptor blockers before TWOC and discourage emergency operative management. Use of SPC over IDC in AUR is debatable. Duration of catheterization is controversial but o3 days is a safe option in avoiding catheterization-related complications. Although TURP remains the current gold standard, there has been an emergence of newer operative management utilizing laser techniques.

Type of Study: Systematic Review and Meta-Analysis

Summary:

            This article goes over the etiology and management options for acute urinary retention. Acute urinary retention is a urological emergency characterized by the inability to fully empty the bladder. It is most common in older men and can be classified into two categories: spontaneous acute urinary retention (sAUR) and precipitated acute urinary retention (pAUR). sAUR occurs secondary to BPH while pAUR may be due to  surgery, medication, alcohol intake, or infections. Acute urinary retention is multifactorial and thought to be due to combination of mechanical and dynamic obstruction as well as a neuropathic issues. Examples of mechanical obstruction include BPH, urethral strictures, urinary tract stones, or cystocele. Dynamic obstruction includes things such as increased alpha-adrenergic activity, and prostatic inflammation. Immediate management of AUR involves bladder decompression via catheterization to relieve discomfort. Decompression must be performed carefully to prevent profound hypotension. For instance, in a patient that has not voided in a few days, 1 liter of urine should be removed before the Foley is tied up. Further decompression to remove the remaining urine may take place after an hour. There are various catheterization options such as urethral catheterization, suprapubic catheterization, and intermittent self-catheterization. In the emergency department, indwelling catheters such as foley catheters are used unless there is an inability to do so such as in cases of urethral trauma. In this case, a suprapubic catheter may be used. In patients with AUR due to BPH, medications such as alpha blockers and 5-alpha reductase inhibitors may be used as adjunct therapy. Surgical intervention is indicated in cases of failed trial without catheter (TWOC) or significant lower urinary tract symptoms.

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