Abstract
Introduction
Anecdotal evidence suggests that current service restrictions and operative cancellations are resulting in increased numbers of catheterized men in the community awaiting definitive management of their bladder outlet obstruction. We wished to analyse current admission policies and management strategies of acute urinary retention (AUR) secondary to benign prostatic enlargement (BPE) in Ireland.
Methods
A total of 58 consultant urologists practicing in Ireland were sent a questionnaire about their management of AUR secondary to BPE. Data was collected relating to initial emergency management, timing of trial without catheter (TWOC), their use of alpha-blockers and follow-up policy.
Results
Urethral catheterization is the initial management of choice by all 42 respondents. The patient is routinely admitted after catheterization by 20/42 consultants (48 %) and 22/42 (52 %) discharge the patient home with a urinary catheter (UC). TWOC is performed on day 2 in 11/20 (55 %) and on day 3 in 9/20 (45 %). In terms of individuals who admit patients presenting with AUR one failed TWOC is an indication for transurethral resection of the prostate in 10/20 (50 %), with 6/20 (30 %) performing a second TWOC on the same admission and 4/20 (20 %) discharging the patient for interval TURP. A total of 83 % of respondents, all of whom work in public institutions, expressed concerns relating to elective admission difficulties for definitive management of catheterized patients following AUR.
Conclusion
There is variation in the admission policy for AUR in Ireland. Elective admission and operative restrictions for catheterized patients following episodes of AUR are causing concern to the urologists in Ireland.
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References
Jacobsen SJ, Jacobson DJ, Girman CJ et al (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158(2):481–487
Meigs JB, Barry MJ, Giovannucci E, Rimm EB, Stampfer MJ, Kawachi I (1999) Incidence rates and risk factors for acute urinary retention: the health professionals followup study. J Urol 162(2):376–382
Verhamme KM, Dieleman JP, van Wijk MA, Bosch JL, Stricker BH, Sturkenboom MC (2005) Low incidence of acute urinary retention in the general male population: the triumph project. Eur Urol 47(4):494–498
Cathcart P, van der Meulen J, Armitage J, Emberton M (2006) Incidence of primary and recurrent acute urinary retention between 1998 and 2003 in England. J Urol 176(1):200–204 Discussion 4
Pickard R, Emberton M, Neal DE (1998) The management of men with acute urinary retention. National Prostatectomy Audit Steering Group. Br J Urol 81(5):712–720
Holtgrewe HL, Mebust WK, Dowd JB et al (1989) Transurethral prostatectomy: practice aspects of the dominant operation in American urology. J Urol 141(2):248–253
Roehrborn CG (2005) Acute urinary retention: risks and management. Rev Urol 7(Suppl 4):S31–S41
Fitzpatrick JM, Desgrandchamps F, Adjali K et al (2012) Management of acute urinary retention: a worldwide survey of 6,074 men with benign prostatic hyperplasia. BJU Int 109(1):88–95
Taube M, Gajraj H (1989) Trial without catheter following acute retention of urine. Br J Urol 63(2):180–182
Hastie KJ, Dickinson AJ, Ahmad R, Moisey CU (1990) Acute retention of urine: is trial without catheter justified? J R Coll Surg Edinb 35(4):225–227
McNeill SA, Daruwala PD, Mitchell ID, Shearer MG, Hargreave TB (1999) Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled. BJU Int 84(6):622–627
Fitzpatrick JM (2006) The natural history of benign prostatic hyperplasia. BJU Int 97(Suppl 2):3–6 Discussion 21–2
Bates TS, Sugiono M, James ED, Stott MA, Pocock RD (2003) Is the conservative management of chronic retention in men ever justified? BJU Int 92(6):581–583
Zeif HJ, Subramonian K (2009) Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. Cochrane Database Syst Rev 4:CD006744
Nasr A, Reichardt K, Fitzgerald K, Arumugusamy M, Keeling P, Walsh TN (2004) Impact of emergency admissions on elective surgical workload. Ir J Med Sci 173(3):133–135
Robb WB, O’Sullivan MJ, Brannigan AE, Bouchier-Hayes DJ (2004) Are elective surgical operations cancelled due to increasing medical admissions? Ir J Med Sci 173(3):129–132
Cravens DD, Zweig S (2000) Urinary catheter management. Am Fam Physician 61(2):369–376
Kunin CM, Douthitt S, Dancing J, Anderson J, Moeschberger M (1992) The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 135(3):291–301
Manikandan R, Srirangam SJ, O’Reilly PH, Collins GN (2004) Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey. BJU Int 93(1):84–88
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Cullen, I.M., Dowling, C.M., Thornhill, J.A. et al. Emergency management of acute urinary retention: results from an all-Ireland urologist practice survey. Ir J Med Sci 182, 207–211 (2013). https://doi.org/10.1007/s11845-012-0859-9
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DOI: https://doi.org/10.1007/s11845-012-0859-9