Urinary retention: issues of management and care

Incidence of urinary retention and relations between patient's complaint, physical examination, and bladder ultrasound

OBJECTIVE

To describe the frequency of urinary complaints, bladder globe, and need for bladder relief catheterization according to ultrasound; to investigate the relationship between the urinary volume estimated by ultrasound and the one drained in catheterization; and to describe the relationship of patient's complaints and detection of bladder globe with the diagnosis of urinary retention.

METHOD

A cross-sectional study with clinical patients with suspected urinary retention in a tertiary hospital, conducted from February to September 2018. Urinary volume ≥500 mL in ultrasound was considered urinary retention.

RESULTS

Two hundred and five evaluations were performed in 44 patients. Urinary retention was detected by ultrasound in 33.2% of the evaluations. There was a strong correlation between ultrasound and bladder catheterization. There was a higher frequency of identification of bladder globe in urinary volumes ≥300 mL.

CONCLUSION

The incidence of urinary retention was higher when ultrasound was used for the diagnosis, when compared to patient's complaint and physical examination. Ultrasound showed to be accurate in establishing urinary volume.

Impact and costs of home-based trial of void compared with the day care setting

AIMS

This paper presents the relative merits and comparative costs of conducting trial of void using Hospital-In-The-Home vs. the Day Procedure Unit.

BACKGROUND

Hospitals increasingly discharge patients with acute urinary retention with indwelling urinary catheters. For these to be removed and patients supported to return to normal urinary function, outpatient or in-home services are used. To date, the relative effectiveness and costs of Hospital-In-The-Home care and Day Procedure Unit care for trial of void have not been examined.

DESIGN

This retrospective study used a static-group comparison design.

METHODS

Hospital administrative data from 1 February 2009-30 March 2011 for patients having trial of void in the Day Procedure Unit (n = 107) and Hospital-In-The-Home (n = 163) of a tertiary hospital in Western Australia were compared in terms of patient outcomes and costs.

RESULTS

Day Procedure Unit patients had longer wait times than Hospital-In-The-Home patients; there was no difference between the two groups for average per patient days of service or successful first trials. Hospital-In-The-Home care did not increase the overall period of care. Per patient average ward-equivalent cost in the Day Procedure Unit was A$396 higher than the Hospital-In-The-Home ward-equivalent cost. The average cost saving per patient for Hospital-In-The-Home care including trial of void cost and emergency department visits was A$117.

CONCLUSION

Patient outcomes from Hospital-In-The-Home trial of void in low-risk patients were comparable to those of Day Procedure Unit care and less costly. Hospital-In-The-Home care for this well-defined procedure could permit more efficient management of patient throughput.