Long Term Outcomes of Expectant Management in Patients with Incomplete Bladder Emptying & Chronic Urinary Retention
Alejandro Abello, MD; William C. DeWolf, MD, FACS, Anurag K. Das, MD, FACS
Beth Israel Deaconess Medical Center, Boston, MA
Introduction and Objective: Large volume incomplete bladder emptying / chronic urinary retention (CUR) has been associated with many complications, including acute retention, renal failure, infections and stones. The American Urological Association recently defined CUR and recommended a treatment algorithm based on a variety of factors. In this report, we evaluated the relationship between chronically elevated post-void residual (PVR) volumes and adverse outcomes during long-term follow-up.
Patients and methods: Between 2002 and 2016, non-neurogenic patients who had PVR volumes > 300 ml by bladder ultrasound or catheterization on two or more separate occasions at least six months apart were included. We followed this cohort over time and recorded complications including upper and lower urinary tract infection (UTI), acute retention (AUR), urosepsis, stones, hydronephrosis, and acute and chronic renal failure. The cohort was then divided in 2 groups based on baseline PVR cutoffs (300-450ml and >450ml) and complications were compared and analyzed. Finally, we correlated predisposing factors and complications.
Results: There were 28 male patients with a mean age of 74 who met inclusion criteria and were followed for a mean of 65 months (Range: 6-198 months); 26 had benign prostatic hyperplasia (BPH) with a median prostate size of 55 cc (IQR: 35-86), and 24 were receiving medical therapy. Other patient and UDS characteristics are show in Table 1. Baseline median PVR corresponded to 468 ml (IQR: 395-828), follow-up median PVR was 508 ml (IQR: 322-714) and last visit median PVR was 508 ml (IQR: 300-850). During follow-up, 16 patients (57%) had at least 1 complication with acute urinary retention being the most common occurring in 13 patients with 18 episodes. The other complications were rare and presented in less than 15%. No patients had worsened renal insufficiency with the mean final recorded creatinine being 1.1. No statistically significant difference was found for any studied complication between the 2 different PVR cut-offs. Patients with prostate size ≥ 100cc had significantly higher total number of AUR episodes (P value: 0.02) and symptomatic UTIs (P value: 0.03). There was also a strong positive correlation (r= 0.7, P < 0.001) between prostate size and total number of AUR episodes.
Conclusion: While the presence of CUR could predispose to episodes of acute retention, other complications are infrequent. Additionally, prostate size may play a role in increasing some complications. Certain patients can be safely followed for at least 5 years without renal deterioration and low risk of other complications.
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