DOCSLIB.ORG

Urinary Retention in Surgical Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Urinary Retention in Surgical Patients Urinary Retention in Surgical Patients a b, Urszula Kowalik, MD , Mark K. Plante, MD, FRCS(C) * KEYWORDS Urinary retention Postoperative Surgery Bladder function KEY POINTS Urinary retention, in some cases, is a preventable complication in general surgical patients in the postoperative setting. Urinary retention can be secondary to outlet obstruction, disruption of innervation to the bladder, or bladder overdistention. The goals for prevention should include identification of patients at risk. Risk factors known to be associated with increased risk of acute retention are age, medications, an- esthetics, benign prostatic hyperplasia/lower urinary tract symptoms, and surgery- related factors, including operating room time, intravenous fluids, and procedure type. Diagnosis of urinary retention is best confirmed by bladder scan, as symptoms, such as pain and urge to void, are unreliable. The mainstay of initial management of urinary retention is placement of a Foley catheter. Alpha-blockers should be started, as they increase the likelihood of a successful voiding trial. URINARY RETENTION Urinary retention in surgical patients is a common source of morbidity and can result in added costs that can potentially be avoided. Over the years, the urologic, general sur- gical, orthopedic, and anesthesia literature have addressed the problem; however, the definitions remain unclear with few if any guidelines for prevention and management. Recommendations for patients with increased baseline risk, that is, patients with known benign prostatic hyperplasia (BPH), are scarce as well. Studies on the topic are generally very heterogeneous with varying populations, operative conditions, and notably what constitutes retention. This article mainly focuses on the risk factors Disclosure Statement: The authors have nothing to disclose. a University of Vermont Medical Center, 111 Colchester Avenue, Mailstop 222WP2, Burlington, VT 05401, USA; b Division of Urology, Department of Surgery, University of Vermont Medical Center, University of Vermont College of Medicine, 111 Colchester Avenue, Mailstop 320FL4, Burlington, VT 05401, USA * Corresponding author. E-mail address: [email protected] Surg Clin N Am 96 (2016) 453–467 http://dx.doi.org/10.1016/j.suc.2016.02.004 surgical.theclinics.com 0039-6109/16/$ – see front matter Ó 2016 Elsevier Inc. All rights reserved. 454 Kowalik & Plante for and subsequent management of postoperative urinary retention (POUR) as it is commonly encountered by the general surgeon and has been shown to be responsible for up to 20% to 25% of unplanned admissions after ambulatory surgery.1,2 Definitions Urinary retention has taken on many definitions in the literature but can be best described as the inability to spontaneously and adequately empty the bladder. This definition is broad as it encompasses what has been described as acute versus chronic as well as complete versus incomplete retention. The categories are not mutu- ally exclusive as both acute and chronic retention can be complete or incomplete and the literature has used a combination of other varying definitions making it very difficult to compare studies. Acute urinary retention (AUR) is one of the few true urologic emergencies. The Inter- national Continence Society (ICS) defines AUR as a “painful, palpable or percussible bladder, when the patient is unable to pass any urine.”3 It can be spontaneous or sec- ondary to surgery, medications, BPH, cerebrovascular accident, immobility, or anes- thesia. In the case of BPH-related AUR, McNeil4 found that differentiating between spontaneous and precipitated AUR was not important as the management did not change, whereas precipitated AUR unrelated to BPH may require altered management. Chronic urinary retention is described by the ICS as “a non-painful bladder, which remains palpable or percussible after the patient has passed urine.”3 This definition includes patients with high postvoid residuals (PVRs) as well as those who fail a trial of voiding without a catheter placed for AUR. These patients often times require sur- gical intervention; however, given that long-term complication rates related to the retention are low,5 conservative management may be considered based on unique patient factors. At present, no precise definition of POUR exists, even among urologists. It is also very important to note that most cases of urinary retention are not associated with either a palpable or percussible bladder. Epidemiology AUR is reported to occur in 0.2% to 0.6% of the general population.6,7 This number increases to 2.0% to 3.8% in the general surgical population.8,9 Several recent studies have reported POUR rates of up 14% to 16% in surgical patients overall. These differ- ences may best be explained by the heterogeneity of surgical patient populations and the overall operative conditions as some types of procedures have drastically increased rates of POUR as compared with those evidenced in the general population. Two examples of these much higher rates of POUR are anorectal surgeries and total joint arthroplasties with reported rates of retention ranging from 20% to 48%10–12 and 0% to 75%,13 respectively. Pathophysiology Normal bladder function Normal bladder function involves both the storage and emptying of urine. It is controlled by supraspinal and medullary centers via autonomic and somatic pathways (Fig. 1). In order for micturition to occur, the external sphincter must relax via quiescence of the somatic innervation (pudendal nerve S2–S4) and the detrusor must then contract which requires activation of the parasympathetics (pelvic nerve S2–S4) and inhibition of sympathetics (hypogastric nerve T10–L2). During micturition, parasympathetic innervation also allows for urethral smooth muscle to relax.14 Urinary Retention in Surgical Patients 455 Fig. 1. Micturition reflex pathway. (Courtesy of the McGill Molson Medical Informatics Proj- ect, Montreal, Quebec, Canada, with permission.) Normal bladder capacity of an adult is 400 to 600 mL. The first need to void is usually experienced at 150 mL, and the urge to void is experienced by 300 mL. In general, PVRs should be less than 10% of bladder capacity. Studies evaluating voiding trials have used a variety of definitions; however, no consensus exists as to what maximum PVR is acceptable in order to still have a trial void without catheter to be deemed successful. Cause of retention The exact mechanisms that contribute to urinary retention have yet to be established, although 3 causes have been suggested as likely candidates. Obstruction: either mechanical or dynamic Mechanical obstruction may be either due to urethral strictures or possibly a change in bladder position and/or edema in the pelvis after surgery. It has long been thought that BPH with a large, ball-valving median lobe and/or, more recently, intravesical prostatic protrusion can contribute; however, no studies have clearly established this relationship and further investigation is warranted. Dynamic obstruction can be secondary to increased tone. For instance, anorectal stimulation during surgery can increase alpha-adrenergic activity, which causes bladder outlet obstruction.15 Disruption of the innervation: sensory and motor pathways Drugs inhibiting detrusor contraction, spinal anesthetics inhibiting the sacral reflex micturition loop, and injury to 456 Kowalik & Plante the nerves during pelvic surgery can all play a role. For instance, during rectal cancer surgery, autonomic nerve damage during total mesorectal excision or lymph node dissection can cause urinary dysfunction.15 Overdistention: myogenic failure Overfilling of the bladder during surgery can lead to overstretching of the smooth muscle detrusor fibers in addition to possible muscle fa- tigue, ischemia, and even axonal degeneration. Myogenic failure is directly influenced by both intravenous (IV) fluid administration and the total anesthesia/surgery time. Risk Factors Because of the enormous variability of the patient populations studied, mixed results exist on which risk factors are most relevant to predisposing to urinary retention. Furthermore, some risk factors may be more important in certain types of procedures while seemingly having little to no impact on others. Age Degeneration of neural pathways involved with bladder function is thought to be responsible for the increased risk of POUR in older patients. A recent meta-analysis of 21 studies, involving 7802 patients, found that increased age significantly increased the risk of POUR with an odds ratio (OR) of 2.11 for those patients older than 60 years.16,17 Other studies have suggested that as early older than 50 years is a signif- icant risk factor.18,19 Sex Sex has been clearly shown to be a risk factor for urinary retention not related to sur- gery given many men have BPH, which is clearly a risk factor for lower urinary tract dysfunction and retention. Importantly, however, this association has not been as strongly elucidated for POUR.17,18,20 Mason and colleagues16 found no association in a meta-analysis of 10 studies, including 5624 patients, between sex and POUR. Medications Anticholinergics and medications with anticholinergic properties (antipsychotics, antihistamines, antiemetics, antidepressants, sedatives) can directly inhibit de- trusor contractility as well as promote sedation, delirium, and constipation (Table 1). Alpha-adrenergic agonists can directly increase urinary sphincter tone. Opiates decrease both bladder contractility and the sensation for urge
Load more

Recommended publications
  • Lower Urinary Tract Function in Patients with Pituitary Adenoma
    390 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2004.044644 on 16 February 2005. Downloaded from PAPER Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus T Yamamoto, R Sakakibara, T Uchiyama, Z Liu, T Ito, T Yamanishi, T Hattori ............................................................................................................................... J Neurol Neurosurg Psychiatry 2005;76:390–394. doi: 10.1136/jnnp.2004.044644 Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. See end of article for Objective: To investigate LUT function in patients with pituitary adenomas. authors’ affiliations ....................... Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. Correspondence to: Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and Dr Ryuji Sakakibara, Neurology Department, frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, Chiba University, 1–8–1 psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate Inohana Chuo-ku, Chiba secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and 260–8670, Japan; sakakibara@faculty. subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the chiba-u.jp tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing Received 2 May 2004 sphincter in one.
    [Show full text]
  • Micturition Disturbance in Acute Transverse Myelitis
    Spinal Cord (1996) 34, 481- 485 © 1996 International Medical Society of Paraplegia All rights reserved 1362-4393/96 $12.00 Micturition disturbance in acute transverse myelitis Ryuji Sakakibara1,2, Takamichi Hattori2, Kosaku Yasuda3 and Tomonori Yamanish? IDepartment of Neurology, Kashima Rosai Hospital, Kashima; 2Department of Neurology and 3Urology, Chiba University School of Medicine, Chiba, Japan In ten patients with acute transverse myelitis (ATM), seven patients had urinary retention, and the other three patients had difficulty in voiding within 1 month from the onset of the disease. Five of the patients with retention became able to urinate. After the mean follow-up period of 40 months, nine still had urinary symptoms including difficulty in voiding in five and urinary frequency, urgency and incontinence in four patients. Four patients had urinary disturbance as the sole sequel of ATM. Urodynamic studies performed on nine patients revealed that all of the three patients with the urgent incontinence had detrusor hyperreflexia, all of the four patients with retention had an areflexic cystometrogram as well as sphincter hyperreflexia, and three of five patients with voiding difficulty had detrusor-sphincter dyssynergia. An areflexic cystometrogram tended to change to a low compliance bladder, followed by detrusor hyperreflexia or a normal cystometrogram. Analysis of the motor unit potentials of the external sphincter revealed that two of the three patients had high amplitude or polyphasic neurogenic changes. Supranuclear as well as nuclear types of parasympathetic and somatic nerve dysfunctions seemed to be responsible for micturition disturbance in our patients with ATM. Keywords: acute transverse myelitis; micturition disturbance; urodynamic study Introduction Acute transverse myelitis (A TM) is a rare but well years ranging from 15 -57 years.
    [Show full text]
  • Urinary System Diseases and Disorders
    URINARY SYSTEM DISEASES AND DISORDERS BERRYHILL & CASHION HS1 2017-2018 - CYSTITIS INFLAMMATION OF THE BLADDER CAUSE=PATHOGENS ENTERING THE URINARY MEATUS CYSTITIS • MORE COMMON IN FEMALES DUE TO SHORT URETHRA • SYMPTOMS=FREQUENT URINATION, HEMATURIA, LOWER BACK PAIN, BLADDER SPASM, FEVER • TREATMENT=ANTIBIOTICS, INCREASE FLUID INTAKE GLOMERULONEPHRITIS • AKA NEPHRITIS • INFLAMMATION OF THE GLOMERULUS • CAN BE ACUTE OR CHRONIC ACUTE GLOMERULONEPHRITIS • USUALLY FOLLOWS A STREPTOCOCCAL INFECTION LIKE STREP THROAT, SCARLET FEVER, RHEUMATIC FEVER • SYMPTOMS=CHILLS, FEVER, FATIGUE, EDEMA, OLIGURIA, HEMATURIA, ALBUMINURIA ACUTE GLOMERULONEPHRITIS • TREATMENT=REST, SALT RESTRICTION, MAINTAIN FLUID & ELECTROLYTE BALANCE, ANTIPYRETICS, DIURETICS, ANTIBIOTICS • WITH TREATMENT, KIDNEY FUNCTION IS USUALLY RESTORED, & PROGNOSIS IS GOOD CHRONIC GLOMERULONEPHRITIS • REPEATED CASES OF ACUTE NEPHRITIS CAN CAUSE CHRONIC NEPHRITIS • PROGRESSIVE, CAUSES SCARRING & SCLEROSING OF GLOMERULI • EARLY SYMPTOMS=HEMATURIA, ALBUMINURIA, HTN • WITH DISEASE PROGRESSION MORE GLOMERULI ARE DESTROYED CHRONIC GLOMERULONEPHRITIS • LATER SYMPTOMS=EDEMA, FATIGUE, ANEMIA, HTN, ANOREXIA, WEIGHT LOSS, CHF, PYURIA, RENAL FAILURE, DEATH • TREATMENT=LOW NA DIET, ANTIHYPERTENSIVE MEDS, MAINTAIN FLUIDS & ELECTROLYTES, HEMODIALYSIS, KIDNEY TRANSPLANT WHEN BOTH KIDNEYS ARE SEVERELY DAMAGED PYELONEPHRITIS • INFLAMMATION OF THE KIDNEY & RENAL PELVIS • CAUSE=PYOGENIC (PUS-FORMING) BACTERIA • SYMPTOMS=CHILLS, FEVER, BACK PAIN, FATIGUE, DYSURIA, HEMATURIA, PYURIA • TREATMENT=ANTIBIOTICS,
    [Show full text]
  • Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30
    W16: Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30 Start End Topic Speakers 08:30 08:45 Urinary retention in women: concepts and pathophysiology David Castro-Diaz 08:45 08:50 Discussion All 08:50 09:05 Evaluation Tufan Tarcan 09:05 09:10 Discussion All 09:10 09:30 Conservative management Cristina Naranjo-Ortiz 09:30 09:35 Discussion All 09:35 09:55 Medical and surgical management Christopher Chapple 09:55 10:00 Discussion All 10:00 10:30 Break None 10:30 11:20 Typical clinical cases discussion All 11:20 11:30 Take home messages David Castro-Diaz Aims of course/workshop Urinary retention in women is rare and diverse. Diagnostic criteria are not agreed and epidemiology is not well known. Forms of urinary retention in women include: complete retention, incomplete or insufficient emptying and elevated post-void residual. It may be acute or chronic, symptomatic or asymptomatic. Etiology is multifactorial including anatomic or functional bladder outlet obstruction and bladder dysfunction related to neurological diseases, diabetes mellitus, aging, pharmacotherapy, pain and infective/inflammatory disease and idiopathic or unknown aetiology. This workshop will analyse and discuss physiopathology, evaluation and management of urinary retention in women from an integral, practical and evidence based approach. Learning Objectives 1. Identify urinary retention in women, its etiology and risk factors. 2. Carry out proper diagnosis of urinary retention in women as well as its relationship with risk and influent factors. 3. Properly manage female acute and chronic acute and chronic urinary retention with the different approaches including conservative, medical and surgical therapies.
    [Show full text]
  • Nerve Disease and Bladder Control
    Nerve Disease and Bladder Control National Kidney and Urologic Diseases Information Clearinghouse For the urinary system to do its job, muscles and nerves must work together to hold Brain urine in the bladder and then release it at the right time. Nerves carry messages from NATIONAL the bladder to the brain to let it know when INSTITUTES the bladder is full. They also carry messages OF HEALTH Central nervous from the brain to the bladder, telling muscles system (brain either to tighten or release. A nerve prob­ and spinal cord) lem might affect your bladder control if the nerves that are supposed to carry messages Spinal cord between the brain and the bladder do not work properly. Nerve signals U.S. Department to bladder of Health and Bladder and sphincter Human Services What bladder control muscles problems does nerve damage cause? Nerves that work poorly can lead to three Urethra different kinds of bladder control problems. Overactive bladder. Damaged nerves may Sphincter muscles send signals to the bladder at the wrong time, causing its muscles to squeeze with­ Nerves carry signals from the brain to the bladder out warning. The symptoms of overactive and sphincter. bladder include • urinary frequency—defined as urination eight or more times a day or two or nerves to the sphincter muscles are dam­ more times at night aged, the muscles may become loose and allow leakage or stay tight when you are • urinary urgency—the sudden, strong trying to release urine. need to urinate immediately Urine retention. For some people, nerve • urge incontinence—leakage of urine damage means their bladder muscles do that follows a sudden, strong urge to not get the message that it is time to release urinate urine or are too weak to completely empty Poor control of sphincter muscles.
    [Show full text]
  • Urinary Retention in Adults:​ Evaluation and Initial Management David C
    Urinary Retention in Adults: Evaluation and Initial Management David C. Serlin, MD; Joel J. Heidelbaugh, MD; and John T. Stoffel, MD University of Michigan Medical School, Ann Arbor, Michigan Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine. The condition predominantly affects men. The most common causes are obstructive in nature, with benign prostatic hyperplasia accounting for 53% of cases. Infectious, inflammatory, iatrogenic, and neurologic causes can also affect urinary retention. Initial evaluation should involve a detailed his- tory that includes information about current prescription medications and use of over-the-counter medications and herbal supplements. A focused physical examination with neurologic evaluation should be performed, and diagnostic testing should include measurement of postvoid residual (PVR) volume of urine. There is no consensus regarding a PVR-based definition for acute urinary retention; the American Urological Association recommends that chronic urinary retention be defined as PVR volume greater than 300 mL measured on two separate occasions and persisting for at least six months. Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization. Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term; silver alloy–coated and antibiotic-impregnated catheters offer clinically insignificant or no benefit. Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials. Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists.
    [Show full text]
  • Questions to Ask a Patient with Nocturia
    CLINICAL Questions to ask a patient with nocturia Wendy F Bower, Karel Everaert, NOCTURIA, defined as waking up from Question 1: How many times do Tee J Ong, Claire F Ervin, sleep to pass urine, is rarely benign. you wake up at night to pass urine? Jens P Norgaard, Michael Whishaw Individuals who void at least twice per The onset and duration of nocturia, night have over four times the risk of number of awakenings at night and relative developing cardiovascular disease and bother should be clarified. In particular, Background double the risk of early death, even when waking from sleep with an urge to void Patients may not raise nocturia as a controlled for known risk factors for should be differentiated from voids made concern as they mistakenly consider the 1 symptom to be a normal part of ageing. mortality. Health issues, such as diabetes, ‘just in case’, which are common in those Nocturia is associated with significant hypertension, cardiovascular disorders, who wake because of sleep disturbance. morbidity and is likely to be a marker mental health problems and obesity, are of poor health. more common in people with nocturia, Question 2: How much does nocturia generating up to a threefold increase in bother you? Objectives 2–5 This paper provides questions to guide the use of healthcare services. Persistent nocturia signals impair sleep diagnosis, evaluation and individualised Figure 1 summarises the possible quality for most patients, usually reducing treatment of nocturia. underlying causes of nocturia, many of the time per cycle spent in slow-wave sleep. which co-exist, interact and lie outside Many older patients do not automatically Discussion the urinary tract system.6–8 There is associate nocturia with their poor sleep, Nocturia results from the interplay an age-related increase in nocturnal although the symptoms drive each other.
    [Show full text]
  • Urinary Retention in Adults: Diagnosis and Initial Management Brian A
    Urinary Retention in Adults: Diagnosis and Initial Management BRIAN a. SELIUS, DO, and rAJESH SUBEDI, MD, Northeastern Ohio Universities College of Medicine, St. Elizabeth Health Center, Youngstown, Ohio Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neuro- logic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha- adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and com- plete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheteriza- tion may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments. (Am Fam Physician. 2008;77(5):643-650. Copyright © 2008 American Academy of Family Physicians.) rinary retention is the inabil- physician to make an accurate diagnosis ity to voluntarily urinate.
    [Show full text]
  • Clinical Procedure for the Management of High Pressure Chronic Retention of Urine + Post-Obstructive Diuresis
    Clinical Procedure for the Management of High Pressure Chronic Retention of Urine + Post-Obstructive Diuresis For use in: Wards and A&E By: All Medical staff Junior Doctors / Specialist Nurses / For: Physician Associates Division responsible for document: Surgical Division Retention, high pressure, diuresis, Key words: hydronephrosis Name of document author: Melissa Gabriel Job title of document author: IST Urology Trainee Name of document author’s Line Manager: Neil Burgess Job title of author’s Line Manager: Consultant Urologist Mr Mark Rochester Supported by: Urology Service Director / Consultant Department Governance Meeting 10 December 2019 Urology Division Governance Assessed and approved by the: 31 December 2019 Clinical Guidelines Assessment Panel (CGAP) Chair Date of approval: 27/07/2020 Ratified by or reported as approved to (if Clinical Safety and Effectiveness Sub-Board applicable): To be reviewed before: This document remains current after this date 05/02/2023 but will be under review To be reviewed by: Neil Burgess Reference and / or Trust Docs ID No: 16931 Version No: 1.1 Compliance links: (is there any NICE related to N/A guidance) If Yes - does the strategy/policy deviate No Clinical Procedure for: Management of High Pressure Chronic Retention of Urine + Post-Obstructive Diuresis Author/s: Dr M Gabriel and Mr N. Burgess Author/s title: IST Urology Trainee and Consultant Urologist Approved by: CGAP Chair Date approved: 27/07/2020 Review date: 05/02/2023 Available via Trust Docs Version: 1.1 Trust Docs ID: 16931 Page 1 of 5 Clinical Procedure for the Management of High Pressure Chronic Retention of Urine + Post-Obstructive Diuresis from the recommendations of NICE? If so why? Version and Document Control: Version Date of Change Description Author Number Update 27/07/202 1.1 Monitoring compliance wording added Melissa Gabriel 0 This is a Controlled Document Printed copies of this document may not be up to date.
    [Show full text]
  • Nocturia: the Complex Role of the Heart, Kidneys, and Bladder
    EUF-773; No. of Pages 3 E U R O P E A N U R O L O G Y F O C U S X X X ( 2 0 1 9 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europeanurology.com/eufocus Mini Review – Voiding Dysfunction Nocturia: The Complex Role of the Heart, Kidneys, and Bladder a,* a b Riccardo Lombardo , Andrea Tubaro , Fiona Burkhard a b Ospedale Sant’ Andrea, Sapienza University of Rome, Rome, Italy; Department of Urology, Inselspital University Hospital Bern, Bern, Switzerland Article info Abstract Article history: We review the role of the heart, kidneys, and bladder in the pathophysiology of nocturia Accepted July 25, 2019 and nocturnal polyuria. Lower urinary tract symptoms such as nocturia have often been associated with lower urinary tract dysfunction. It is known that the bladder contributes Associate Editor: to nocturia in the case of low functional capacity, urgency, and detrusor overactivity. Heart diseases, especially arterial hypertension and congestive heart failure, are closely Malte Rieken related to nocturnal polyuria. The main mechanisms include renal hyperfiltration and elevated atrial natriuretic peptide. A number of drugs frequently used in cardiovascular Keywords: disorders are implicated in nocturia; diuretics, calcium channel blockers, and b-blockers Nocturia induce nocturnal polyuria and thus nocturia, whereas alpha-blockers improve nocturia. Among the different forms of hypertension, nondipping arterial hypertension has been Nocturnal polyuria associated with a higher risk of nocturnal polyuria. Besides the role of the kidneys in Physiopathology nocturia linked to arterial hypertension, chronic kidney disease is an independent predictor of nocturia through an osmotic diuresis mechanism.
    [Show full text]
  • An Evidence-Based Approach to Emergency Department Management of Acute Urinary Retention
    January 2014 An Evidence-Based Approach Volume 16, Number 1 To Emergency Department Authors John R. Marshall, MD Department of Emergency Medicine, Lincoln Medical and Mental Management Of Health Center, Bronx, NY Jordana Haber, MD Department of Emergency Medicine, Maimonides Medical Center, Acute Urinary Retention Brooklyn, NY Elaine B. Josephson, MD, FACEP Assistant Professor of Emergency Medicine in Clinical Medicine, Abstract Weill Cornell Medical College of Cornell University, New York, NY; Emergency Medicine Residency Program Director, Lincoln Medical and Mental Health Center, Bronx, NY Approximately 10% of men in their 70s and 33% of men in their 80s report at least 1 episode of acute urinary retention, and this urologi- Peer Reviewers cal emergency presents unique assessment and treatment challenges William J. Brady, MD Professor of Emergency Medicine and Medicine, Chair, Medical in the emergency department setting. Patients presenting with Emergency Response Committee, Medical Director, Emergency acute urinary retention are often in severe pain and require urgent Management, University of Virginia Medical Center, Charlottesville, VA diagnosis and prompt treatment. The differential diagnosis of acute Joseph D. Toscano, MD urinary retention is vast, with some causes leading to permanent Chairman, Department of Emergency Medicine, San Ramon Regional Medical Center, San Ramon, CA impairment if not dealt with in a timely manner. Quick recogni- tion of the cause and timely bladder decompression are of utmost CME Objectives importance in preventing morbidity and relieving pain. This review Upon completion of this article, you should be able to: analyzes the etiology, key historical and physical findings, differen- 1. Describe the pathophysiology and complications of AUR.
    [Show full text]
  • Overactive Bladder Syndrome Management and Treatment Options Janine Arnold Nicholas Mcleod Ruban Thani-Gasalam Prem Rashid
    CLINICAL Overactive bladder syndrome Management and treatment options Janine Arnold Nicholas McLeod Ruban Thani-Gasalam Prem Rashid When compared with demographically matched Background controls, patients with OBS have:10,11 Overactive bladder syndrome is a symptom-based clinical diagnosis. It is • significantly less work productivity characterised by urinary urgency, frequency and nocturia, with or without urge • less sexual satisfaction and more erectile urinary incontinence. These symptoms can often be managed in the primary care dysfunction setting. • higher rates of depressive symptoms Objective • significantly poorer mental health This article provides a review on overactive bladder syndrome and provides advice • poorer quality of sleep. on management for the general practitioner. Postmenopausal women with urge incontinence Discussion have a significantly higher risk of falling and Overactive bladder syndrome can have a significant effect on quality of life, and sustaining a fracture than women without urge affects 12–17% of the population. Prevalence increases with age. The management incontinence.4 of overactive bladder syndrome involves exclusion of underlying pathology. First line treatment includes lifestyle interventions, pelvic floor exercises, bladder Causes training and antimuscarinic agents. Failure of conservative management The symptoms of OBS have many potential causes necessitates urology referral. Second line therapies are more invasive, and include and contributing factors. Normal storage of urine botulinum toxin, neuromodulation or surgical interventions such as augmentation is dependent on spinal reflex mechanisms that cystoplasty or urinary diversion. activate sympathetic and somatic pathways to the Keywords urethral outlet and tonic inhibitory systems in the overactive urinary bladder; urological diseases; urinary incontinence brain that suppress the parasympathetic excitatory outflow to the urinary bladder.4 The normal bladder fills like a compliant balloon, with pressure lower than urethral resistance.
    [Show full text]