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Edit Suggestions

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Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. In the Epidemiology section, we suggest adding: "Urinary retention in females is uncommon, occurring 1 in 100,000 every year, with a female-to-male incidence rate of 1:13.[1] It is usually transient and quite clinically ill-defined in some cases. The causes of UR in women can be multi-factorial, and can be postoperative and postpartum. Prompt urethral catherization usually resolves acute emergency UR.[1]"

2. Add a section called “postoperative urinary retention risk factors” and add the following information:

Postoperative urinary retention risk factors: age, medications, anesthetics, benign prostatic hyperplasia/lower urinary tract symptoms, and surgery related factors, including operating room time, intravenous fluids, and procedure type.[2][3][4][5][6][7][8]

Age:

Older patients can suffer from degeneration of neural pathways involved with bladder function and it can be responsible for the increased risk of postoperative urinary retention.[2] [3]The risk of postoperative urinary retention increases up to 2.11 fold for patients older than 60 years. [2][3]

Sex:

Another risk factor is sex. It has been shown that sex increases risks for urinary retention not related to surgery given.[3] For men, benign prostatic hyperplasia increases risk, due to the fact that it’s a risk factor for lower urinary tract dysfunction and retention.[4] This association has not been as strongly elucidated for postoperative urinary retention.[3][4][5]

Medications:

The following medications are associated with increased risks of postoperative urinary retention: anticholinergics and medications with anticholinergic properties, alpha-adrenergic agonists, opiates (The incidence of opioid precipitated retention in the postoperative setting has been found to be as high as 25%.[6]), nonsteroidal antiinflammatories (NSAIDs) (up to 2 fold. [7]), calcium-channel blockers and beta-adrenergic agonists.[8]

Anesthesia:

General anesthetics can cause bladder atony by acting as smooth muscle relaxants.[3][4] In addition to that, it can directly interfere with autonomic regulation of detrusor tone and predispose patients to bladder overdistention and subsequent retention.[3][4] On the other hand, spinal anesthesia results in a blockade of the micturition reflex.[3][4] Overall, spinal anesthesia shows a higher risk of postoperative urinary retention compared to general anesthesia.[3][4]

Benign prostatic hyperplasia:

Men with benign prostatic hyperplasia are at an increased risk of acute urinary retention.[2] This finding is supported by a meta-analysis of 570 articles. It was established that lower urinary tract symptoms were significantly associated with an increased risk of urinary retention (OR 2.83).[2]

Surgery related:

Operative times longer than 2 hours increased the risk of postoperative urinary retention 3-fold.[3]17 Longer surgery times increase patients’ risks of urinary retention. A rule of thumb suggests that for operative cases lasting longer than 3 hours, a Foley catheter should be inserted preoperatively.[8] Overall, there is a theory that longer operative times, increased amounts of IV fluids, and higher doses of anesthetics and opiates likely all together increase risks of postoperative urinary retention.[8]

3. We suggest describing the pathophysiology of chronic urinary retention in a concise manner.

Chronic urinary retention that is due to bladder blockage which can either be as a result of muscle damage or neurological damage.[9] If the retention is due to neurological damage, there is a disconnect between the brain to muscle communication, thereby inhibiting complete voiding of the bladder.[9] If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.[9]

"The most common cause of chronic urinary retention is BPH. [10] BPH is a result of the ongoing process of testosterone being converted to dihydrotestosterone which stimulates prostate growth.[11] Over the lifetime of an individual, the prostate experiences continual growth due to the testosterone to dihydrotestosterone conversion which can cause the prostate to obstruct the urethra, causing urinary retention.[11]

4. In the treatments section, we suggest that we replace the New York Times citation[12] with an peer-reviewed paper.

Additionally, we suggest adding the following information in regards to self-catheterization such as: "Urinary retention combined with recurrent or chronic urinary tract infection may require continued intermittent self-catheterization as this has been shown to reduce infection.[13] While clean Intermittent self catheterization (CISC) is currently the gold standard for patients with urinary retention--and has a lower infection risk compared to catheterization that stays within the body; however, there can be challenges with compliance for intermediate catheterization. For example, with older demographics, who are incapable or lack the dexterity for self catheterization.[14]

5. Add the following to the diagnosis section:

"Non-neurogenic Chronic Urinary Retention does not have a standardized definition, but urine volumes >300mL can be used as an informal indicator of chronic urinary retention.[9] The retention has to be present for a period of time greater than 6 months, that is to say, 2 separate measurements of urine volume 6 months apart should have a PVR volume >300mL.[9] CUR can be caused by bladder outlet obstruction and/or an underactive bladder (detrusor underactivity).[9]

6. In the first paragraph of the treatment section of the article, there is a sentence that states, “5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal”. However, the citation for this statement actually indicates that alpha blockers, not alpha-reductase inhibitors, increase the chance of normal urination following catheter removal. As such, we would suggest amending the statement to say, “Use of alpha-blockers can provide relief of urinary retention following de-catheterization for both men and women.[15][16]”


In addition, under the “Medication” section of the page, it states, “Some people with BPH are treated with medications. These include tamsulosin to relax smooth muscles in the bladder neck, and finasteride and dutasteride to decrease prostate enlargement.[17]”


Thank you very much for taking time to provide us with feedback. Sunavsky (talk) 17:04, 10 November 2017 (UTC)

  1. ^ a b Özveren, B; Keskin, S (2016). "Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients". Urology Annals. 8 (4): 444–448. doi:10.4103/0974-7796.192111. PMC 5100150. PMID 28057989.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ a b c d e Mason, Sam E.; Scott, Alasdair J.; Mayer, Erik; Purkayastha, Sanjay (2016). "Patient-related risk factors for urinary retention following ambulatory general surgery: a systematic review and meta-analysis". The American Journal of Surgery. 211 (6): 1126–1134. doi:10.1016/j.amjsurg.2015.04.021. hdl:10044/1/27300. PMID 26257154.
  3. ^ a b c d e f g h i j Lamonerie, L.; Marret, E.; Deleuze, A.; Lembert, N.; Dupont, M.; Bonnet, F. (2004-04-01). "Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement". BJA: British Journal of Anaesthesia. 92 (4): 544–546. doi:10.1093/bja/aeh099. ISSN 0007-0912. PMID 14977795.
  4. ^ a b c d e f g Hansen, B. S.; Søreide, E.; Warland, A. M.; Nilsen, O. B. (May 2011). "Risk factors of post-operative urinary retention in hospitalised patients". Acta Anaesthesiologica Scandinavica. 55 (5): 545–548. doi:10.1111/j.1399-6576.2011.02416.x. ISSN 1399-6576. PMID 21418152. S2CID 34166384.
  5. ^ a b Dal Mago, Adilson José; Helayel, Pablo Escovedo; Bianchini, Eduardo; Kozuki, Henrique; de Oliveira Filho, Getúlio Rodrigues (July 2010). "Prevalence and predictive factors of urinary retention assessed by ultrasound in the immediate post-anesthetic period". Revista Brasileira de Anestesiologia. 60 (4): 383–390. doi:10.1016/S0034-7094(10)70047-7. ISSN 1806-907X. PMID 20659610.
  6. ^ a b Verhamme, Katia M. C.; Sturkenboom, Miriam C. J. M.; Stricker, Bruno H. Ch; Bosch, Ruud (2008). "Drug-induced urinary retention: incidence, management and prevention". Drug Safety. 31 (5): 373–388. doi:10.2165/00002018-200831050-00002. ISSN 0114-5916. PMID 18422378. S2CID 30173475.
  7. ^ a b Verhamme, Katia M. C.; Dieleman, Jeanne P.; Van Wijk, Marc A. M.; van der Lei, Johan; Bosch, Joseph L. H. R.; Stricker, Bruno H. C.; Sturkenboom, Miriam C. J. M. (2005-07-11). "Nonsteroidal anti-inflammatory drugs and increased risk of acute urinary retention". Archives of Internal Medicine. 165 (13): 1547–1551. doi:10.1001/archinte.165.13.1547. ISSN 0003-9926. PMID 16009872.
  8. ^ a b c d Kowalik, Urszula; Plante, Mark K. (June 2016). "Urinary Retention in Surgical Patients". The Surgical Clinics of North America. 96 (3): 453–467. doi:10.1016/j.suc.2016.02.004. ISSN 1558-3171. PMID 27261788.
  9. ^ a b c d e f Stoffel, JT (September 2017). "Non-neurogenic Chronic Urinary Retention: What Are We Treating?". Current Urology Reports. 18 (9): 74. doi:10.1007/s11934-017-0719-2. PMID 28730405. S2CID 12989132.
  10. ^ "Urinary Retention". National Institute of Diabetes and Digestive and Kidney Diseases. Aug 2014. Archived from the original on 4 October 2017. Retrieved 31 October 2017.
  11. ^ a b Herati, AS; Kohn, TP; Butler, PR; Lipshultz, LI (June 2017). "Effects of Testosterone on Benign and Malignant Conditions of the Prostate". Current Sexual Health Reports. 9 (2): 65–73. doi:10.1007/s11930-017-0104-7. PMC 5648355. PMID 29056882.
  12. ^ "Clean Intermittent Self-Catheterization Health Information - Causes, Symptoms, Diagnosis, Treatment - NY Times Health". www.nytimes.com. Retrieved 2017-11-07.
  13. ^ Wyndaele, Jean-Jacques; Brauner, Annelie; Geerlings, Suzanne E.; Bela, Koves; Peter, Tenke; Bjerklund-Johanson, Truls E. (December 2012). "Clean intermittent catheterization and urinary tract infection: review and guide for future research". BJU International. 110 (11 Pt C): E910–917. doi:10.1111/j.1464-410X.2012.11549.x. ISSN 1464-410X. PMID 23035877. S2CID 1698665.
  14. ^ Seth, Jai H; Haslam, Collette; Panicker, Jalesh N (2014-02-12). "Ensuring patient adherence to clean intermittent self-catheterization". Patient Preference and Adherence. 8: 191–198. doi:10.2147/PPA.S49060. ISSN 1177-889X. PMC 3928402. PMID 24611001.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ Fisher, Euan; Subramonian, Kesavapillai; Omar, Muhammad Imran (2014-06-10). "The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men". The Cochrane Database of Systematic Reviews (6): CD006744. doi:10.1002/14651858.CD006744.pub3. ISSN 1469-493X. PMID 24913721.
  16. ^ Drake, MarcusJ; Mevcha, Amit (2010-04-01). "Etiology and management of urinary retention in women". Indian Journal of Urology. 26 (2): 230. doi:10.4103/0970-1591.65396. PMID 20877602. S2CID 5195513.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  17. ^ Barragán-Arteaga, I.; Reyes-Vallejo, L. (2016). "Combination therapy for the treatment of lower urinary tract symptoms in men". Revista Mexicana de Urología. 76 (6): 360–369. doi:10.1016/j.uromx.2016.05.007.
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