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Acute Urinary Retention Could Be Deadly

Urologists are finding that men with acute urinary retention, especially those with co-morbidities, are at a much higher risk of death.

One in seven men hospitalized with spontaneous acute urinary retention and one in four with precipitated acute urinary retention died within a year, according to a British population-based study published online in BMJ.

Jan H. P. van der Meulen, Ph.D., of the London School of Hygiene and Tropical Medicine reported, “Overall, one-year mortality was two to three times higher than for the general male population, and was substantially higher among men with co-morbid conditions.”

“Because mortality was highest in the presence of co-morbid conditions, people presenting with acute urinary retention should be given a urological examination and a multidisciplinary review to identify and treat co-morbidity early,” commented Katia M. C. Verhamme, M.D., and Miriam C. J. M. Sturkenboom, Pharm. D., Ph.D., both of the Erasmus Medical Center in Rotterdam, The Netherlands.

In Europe, the majority of urologists would hospitalize patients with acute urinary retention, explains Dr. van der Meulen and colleagues.  This is not the case in the United States.  Most patients are given a urinary catheter and sent home, commented J. Stephen Jones, M.D., of the Cleveland Clinic.

“Unfortunately, a severe limitation of the study is that they don’t define how many patients had retention but did not get admitted to hospital,” said Dr. Jones.  “Nevertheless, their focus is very much on target that the physicians should be aware that this could simply be a harbinger of other co-morbidities.”

Researchers used a national database for the study, analyzing over 170,000 men aged 45 or older who were admitted to National Health Services hospitals in England with a first episode of acute urinary retention between the years 1998 and 2005.

For those men who had spontaneous acute urinary retention as a primary diagnosis or accompanied with a primary diagnosis of benign prostatic hyperplasia, the one-year mortality was 14.7%.  Out of those participants with precipitated retention, 25.3% died within the first year after hospitalization.

And age was also a strong indicator of mortality risk.  One-year mortality increased from about 4% for 45- to 54-year-olds up to about 33% for those 85 or older.

Co-morbidity was determined to be a major factor in mortality.  If the patient had at least one co-morbid condition, his risk of dying within one year of hospitalization doubled in men aged 75 to 84.

But even patients without co-morbidity were at a higher risk of death than the general population.

Researchers of the study concluded that patients with acute urinary retention “are a vulnerable group and may benefit from urgent multidisciplinary care to identify and treat co-morbid conditions.”  This conclusion is especially applicable to the United States, where patients “often may not be getting multidisciplinary care,” Dr. Jones said.

“If urinary retention is the only presenting complaint, the urologist who is not as adept at handling systemic conditions or disease—high blood pressure, diabetes—may not focus as much on that as a medical physician,” concluded Dr. Jones.

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