Acute urinary retention in men: the risks and outcomes with medical therapy

Abstract

This paper is restricted to the discussion of the relatively modern disorder of sudden painful inability to urinate in older men. It was not a common medical problem until the 19th century when, in developed countries, male life expectancy increased to beyond 60 years; it remains an uncommon problem in those developing countries where male life expectancy remains low, particularly in some sub-Saharan African countries where male life expectancy is only 44.8 years.

Evaluation and Treatment of Acute Urinary Retention

“…AUR is a common complaint on presentation to the Emergency Department, increases in incidence with age, and most often occurs in men over the age of 60 years (2). Men in their 70s have a 10% risk of AUR occurring over 5 years, increasing to almost a third of men in their 80s (3).…”

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

“…The term "precipitated" refers to the presence of an unambiguous triggering event (eg, genitourinary instrumentation). This is helpful clinically, because once the precipitating factor has been removed, there is the expectation that normal voiding will return [2]. It also is helpful from a prognostic view point to differentiate between these groups in trials.…”

“…This could be only partially accounted for by the increased age, larger prostate volumes, and greater comorbidity. It is postulated that some of the excess risk is catheter-related [2]. Those sent home with a catheter had outcomes similar to those operated on within a few days of admission.…”

“…Because of these risks and because patients dislike indwelling catheters and the additional costs of community care, TWOC is performed increasingly and there is an increasing emphasis on improving TWOC outcomes [2]. Few structured prospective studies have been carried out on this subject.…”

“…In sub-Saharan Africa where male life expectancy is still below 60 years, AUR remains rare as a consequence of prostatic obstruction, but does complicate other pathologic problems that result in urethral stricture [2]. Only after life expectancy increased to more than 60 years of age did AUR related to the prostate become common.…”