A Study of Etiology, Clinical Profile and Outcome of Patients Presenting with Acute Urinary Retention to a Tertiary Care Hospital

Abstract

Introduction: Acute urinary retention (AUR) is defined as the sudden inability to pass urine even with a distended bladder. A population-based study reported the incidence AUR of 2.2 to 6.8 per 1000 men per year. One in 10 men over the age of 70 may experience AUR within 5 years. In contrast, AUR is rare in women. Definitive management of AUR depends on the precipitating cause which can be medical or surgical. Immediate treatment of AUR is to drain the urinary bladder either by urethral catheterization or by a suprapubic cystostomy. Prospective studies on AUR are few in India, and very less is known regarding its prevalence. In view of this, there is a need to formulate a baseline data in the area of acute urinary retention. Aims and Objectives: 1. To study etiology of Acute Urinary Retention in patients presenting at Tertiary Care Hospital. 2. To study the clinical profile of patients presenting with Acute Urinary Retention to a Tertiary Care Hospital. Material and Methods: It is a Prospective Observational Study conducted on patients visiting the Emergency department, OPD and/or cases admitted in the IPD for Acute Urinary Retention in the department of General Surgery at Tertiary Care Hospital. Relevant history was taken and detailed clinical examination along with appropriate investigation including ultrasonography, etc. were carried out in all cases. Appropriate medical (including medication, urethral catherization or suprapubic catherization) or surgical treatment (like surgeries for urethral stricture, phimosis, urethral calculus etc.) was given to the patient as per standard hospital protocols. Results: Mean Age of the study group was 61.54 years with majority of the patients 68% were more than 60 years of age. Male preponderance was observed in the study group with prevalence ratio of 48 (96%) males to only 2 (4%) females. Most common etiology of acute urinary retention was benign prostate hyperplasia (44%) followed by urethral stricture (26%), carcinoma prostate (6%), phimosis (6%) and bladder neck calculi (4%). Foley's catheterization was done in 41 cases (82%) while supra-pubic catheterization was done in 9 cases (18%) cases. Out of the 36 cases in which trial without catheterization was attempted, 32 were successful. Out of the 45 cases with surgical management, TURP was done in 22 cases while Urethrotomy and Cystolithotrypsy was done in 12 and 4 cases. TURP + bilateral orchidectomy and circumcision was done in 3 and 2 cases respectively. Conclusion: The most common age for presentation with Acute Urinary Retention is 51-70 years and with male predominance. In our study we can conclude that the most common etiology for AUR is Benign Prostatic Hyperplasia followed by Urethral Stricture, Carcinoma of Prostate and Phimosis. The primary management to relieve the retention in an emergency situation is mainly by urethral catheterization failing which Suprapubic catheterization is done but definitive management for AUR is surgical.