Clinical characteristics and outcome of high-pressure chronic urinary retention: A systematic review

Abstract

Background: Although not infrequent, publications on high-pressure chronic urinary retention (HPCR) are limited. Lack of awareness of this condition can lead to delayed diagnosis and suboptimal treatment. This systematic review aimed to describe the clinical characteristics and outcome of HPCR. Methods: Keywords were searched in PubMed, Scopus, EMBASE, LILACS, Cochrane-CENTRAL, APAMED Central and Google Scholar. Relevant articles were added from the list of references of eligible articles. Studies describing any two of the characteristic features related to HPCR were included. Qualitative analysis was performed using the available data. Results: Eight prospective studies with 271 patients ( Mage=66.4 years, range 14–89 years; 263 males) were identified. The commonest presentation was tense painless palpable bladder (99.6%). Late-onset nocturnal enuresis was reported in 68.4%, and resistant hypertension was reported in 41.6%. Elevated levels of serum creatinine were identified in 43–81%. Benign prostatic hyperplasia (64.1%) was the commonest aetiology followed by prostatic malignancy (22.6%). A satisfactory response was seen following the definitive treatment of the underlying aetiology. Initial bladder decompression reversed adverse cardiovascular changes and improved renal function but resulted in post-obstructive diuresis. Heterogeneity of the reported data in available studies was a major limitation. Conclusions: Late-onset nocturnal enuresis, a tense painless and non-tender palpable bladder and treatment-resistant hypertension are important clinical findings which would raise the suspicion of HPCR in the clinical setting. Urinary tract ultrasonography showing upper-tract dilatation and raised serum creatinine support the diagnosis. Definitive treatment targeting the underlying aetiology following careful decompression of the bladder showed satisfactory outcomes. Level of evidence: Level 2a(-).

Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia

“…In a metaanalysis of 20 studies, 603/1163 (52%) of cases were unexplained. 4 This corresponds exactly to the data of our study, where 52% of the cases in the hematospermia control group could not be assigned to an etiology. The reason for the high rate of idiopathic cases could be that only a few patients present early (e.g., within a week) and thus not in the acute phase, so infections, in particular, may not be detected after many months.…”

“…In a meta-analysis of eight studies with 836 patients, a total of 20% of the cases were attributed to an inflammatory cause. 4 In our study, 30% of patients had an infectious/inflammatory cause. This higher prevalence may be due to the fact that we asked all patients to provide a semen sample and also screened for classical uropathogens and STIs in all urine and semen samples.…”

“…Urogenital infections were of major relevance, but the studies were markedly heterogeneous with regard to the diagnostics performed so no reliable percentages could be calculated. 4 Only recently, the European Association of Urology (EAU) Guideline Group published a management algorithm for hematospermia. 5 Acute epididymitis is the most common infection of the scrotum with an incidence of 100-250 per 100,000 males and year.…”

Aetiopathogenesis of urethral stricture disease in a tertiary hospital in Southern Nigeria

“…4,6 In high-pressure chronic urine retention, the pressure buildup in the upper tract affects the function of the kidney leading to renal compromise. 31,32 Retention of urine is a common complication in USD. 33 The most common complication before the presentation was UTI and thirty-three patients (30%) presented because of UTI in this study as shown in Table 5.…”

Urine pH and imaging findings of prostate useful predictors of prolonged duration of hematospermia

“…Although the exact rate of incidence or prevalence is unknown, it has been reported that this disease accounts for 1.5% of patients visiting a urology clinic, while it was also detected in 0.5% of a population that underwent prostate cancer screening ( 1 , 2 ), suggesting it to be relatively uncommon. Commonly described causes of hematospermia are benign conditions, such as infection, prostate and seminal vesicle stones, and abnormalities of the urogenital tract, as well as idiopathic disorders in about half of all cases ( 1 , 3 - 6 ).…”