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Wu MY, Chang JR, Lee YK, Lin PC, Tsai TY. The Effect and Safety of Rapid and Gradual Urinary Decompression in Urine Retention: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1441. [PMID: 36295601 PMCID: PMC9609720 DOI: 10.3390/medicina58101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 09/06/2023]
Abstract
Background and objectives: Trials to evaluate the effect and safety of rapid and gradual urinary decompression have been published for decades. Due to inconclusive results, this study aimed to assess whether rapid bladder decompression increased complications in adults with acute urinary retention. Materials and Methods: We searched the Cochrane Library, EMBASE, Google Scholar, and PubMed databases for articles published from the database inception to 31 August 2021. Studies that compared the effects and complication rates of rapid and gradual urinary decompression in adults with acute urinary retention were included. The primary outcome was post-decompression hematuria, while the secondary outcome was circulatory collapse. Meta-analyses were conducted using random effects models. Sensitivity analyses, tests for publication bias, and trial sequential analyses were conducted. The PROSPERO registration number is CRD42021233457. Results: Overall, four articles were included in the comprehensive analysis, and 435 participants met all the eligibility criteria. In the primary meta-analysis of all four study groups, rapid urinary decompression did not increase the risk of post-decompression hematuria (RR = 0.91; 95% CI: 0.62 to 1.35; p = 0.642). The I2 statistic was 0.0% (p = 0.732), indicating no substantial heterogeneity. In the meta-analysis of randomized controlled studies, the result did not change (RR = 0.89; 95% CI: 0.31 to 2.52; p = 0.824). The Egger's test and Begg test (p = 0.339 and 0.497, respectively) indicated the absence of statistical evidence of publication bias. Leave-one-out sensitivity analysis was conducted and showed the pooled results were robust. In secondary outcome, there were no reported events of circulatory collapse in the current studies. Conclusions: The currently available data suggest that rapid urinary decompression is an effective and safe method with a complication rate similar to that of gradual decompression in an acute urinary retention population. Further large-scale randomized studies are required.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Jer-Ruey Chang
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 622, Taiwan
| | - Yi-Kung Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 622, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Tou-Yuan Tsai
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 622, Taiwan
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Klamfoth JK, Burtson KM. Severe Urinary Retention Resulting in Extreme Post-obstructive Diuresis and Decompressive Hematuria. Cureus 2022; 14:e29626. [PMID: 36176478 PMCID: PMC9512517 DOI: 10.7759/cureus.29626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
Post-obstructive diuresis and decompressive hematuria are rare but potentially serious complications of severe urinary retention. This is a case report of a 73-year-old patient with undiagnosed severe large-volume urinary retention who developed extreme cases of both complications after presenting with progressive weight gain, lower extremity edema, worsening dyspnea, and new-onset urinary incontinence. Upon further evaluation, the patient was determined to have acute renal failure, bilateral hydroureteronephrosis, a severely distended urinary bladder, and an enlarged prostate. Foley catheterization produced 5.9 L of urinary output with initial placement. He required prolonged hospitalization for hemodynamic monitoring requiring fluid resuscitation, serial electrolyte monitoring requiring repletion, acute blood loss anemia requiring four units of red blood cell transfusion, continuous bladder irrigation, three cystoscopies under anesthesia, and intravesicular fibrinolysis inhibitor instillations. This case illustrates an extreme severity of post-obstructive diuresis and decompressive hematuria in chronic urinary retention that has not been previously described in the literature.
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Leinum LR, Berthelsen C, Azawi N. Post-obstructive diuresis; underlying causes and hospitalization. Scand J Urol 2020; 54:253-257. [PMID: 32449436 DOI: 10.1080/21681805.2020.1769181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: This paper aims to estimate the incidence of post-obstructive diuresis (POD) among patients with urinary retention, explore possible underlying causes and identify patients who need hospitalization.Material and methods: This retrospective study includes patients admitted for urinary retention in Zealand University Hospital, Denmark. We collected demographic characteristics, health information and laboratory results from patients' charts and analyzed data statistically.Results: We assessed 64 patients, and POD occurred in 29.7%. A significant correlation was observed between POD and residual urine, serum creatinine, serum urea and systolic and diastolic blood pressure. We identified increased residual urine volume as an independent predictor of POD by OR 1.21 (95% CI: 1.06-1.40), p = 0.006 per 100 mL and creatinine of >120 umol/L is an independent predictor of POD by OR 7.17 (95% CI; 1.63-31.37), p = 0.009. Patients with residual urine at the time of diagnosis of more than 1150 ml will suffer POD with a probability of area under curve (AUC) 0.874 (p < 0.001) with 84% sensitivity and 78% specificity. Patients with creatinine >120 umol/L will suffer POD with a probability of AUC 0.774 (p < 0.001) with 68% sensitivity and 82% specificity.Conclusion: In this small retrospective study residual urine of more than 1150 mL and elevated creatinine are independent predictors of POD in patients with urinary retention. However, larger prospective studies are needed to confirm these findings.
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Affiliation(s)
| | | | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Khara S, Hashemzehi T, Batura D. Post-obstructive diuresis: a complication of urinary retention. Br J Hosp Med (Lond) 2019; 80:C103-C105. [PMID: 31283390 DOI: 10.12968/hmed.2019.80.7.c103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sayani Khara
- Foundation Year 1 Trainee, Department of Urology, London North West University Healthcare NHS Trust, Harrow
| | - Tumaj Hashemzehi
- Clinical Fellow, Department of Urology, London North West University Healthcare NHS Trust, Harrow
| | - Deepak Batura
- Consultant Urological Surgeon, Department of Urology, London North West University Healthcare NHS Trust, Harrow HA1 3UJ
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