5/23/2014
1
ACUTE URINARY RETENTION
Joel Teichman MD FRCSC
Professor, Dept. Urologic Sciences
UBC
St. Paul’s Hospital
FAX ...
5/23/2014
2
Disclosure of Commercial Support
• This program has received no financial support
• This program has received ...
5/23/2014
3
OBJECTIVES
• List 3 medications that can precipitate AUR
• Describe how MS can cause AUR
• Describe how alpha-...
5/23/2014
4
CLASSIFICATION
• Spontaneous AUR
– Due to the bladder
• Bladder decompensation, neurogenic
– Due to the bladde...
5/23/2014
5
WHO IS AT RISK?
• Older males (BPH)
• Middle aged females
(MS)
• Others (older males
with a URI, or surgery)
E...
5/23/2014
6
AUR DEFINITION
• Inability to urinate
• Increased residual volume
– > 300 cc
– Associated with clinical proble...
5/23/2014
7
SPONTANEOUS AUR
• BPH
• With acute change
• Catheter
• Is it an acute increased in alpha
sympathomimetic activ...
5/23/2014
8
MTOPS
NEJM 2003; 349: 2387-98
• N=3047 subjects
• Mean followup 4.5 years
• Double-blind, RCT
• Placebo, doxaz...
5/23/2014
9
MTOPS
NEJM 2003; 349: 2387-98
MTOPS
NEJM 2003; 349: 2387-98
0
10
20
30
40
50
60
70
80
90
Age White PVR
Placebo...
5/23/2014
10
MTOPS
NEJM 2003; 349: 2387-98
CLINICAL PROGRESSION
5/23/2014
11
AUR MTOPS
YEAR 4
5/23/2014
12
DUTASTERIDE
BMJ 2013; 346: 2109
• 1617 subjects
• Placebo vs dutasteride
• 4 years
• Clinical progression (4 ...
5/23/2014
13
DUTASTERIDE BASELINE
DUTASTERIDE
5/23/2014
14
REDUCE
NEJM 2010; 362: 1192
• N=6729, 4 years, 50-75, biopsy negative
• RCT double blind
• Prostate cancer in...
5/23/2014
15
WATCH OUT FOR…
• MS variable presentation
• 10% of women with MS present with acute
voiding dysfunction
• 10-...
Upcoming SlideShare
Loading in...5
×

Sun 0945-acute-urinary-retention- -park

215

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
215
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Sun 0945-acute-urinary-retention- -park

  1. 1. 5/23/2014 1 ACUTE URINARY RETENTION Joel Teichman MD FRCSC Professor, Dept. Urologic Sciences UBC St. Paul’s Hospital FAX 604-806-8666 jteichman@providencehealth.bc.ca Faculty/Presenter Disclosure • Faculty: Joel Teichman MD FRCSC • Relationships with commercial interests: – Grants/Research Support: Cook Urological – Speakers Bureau/Honoraria: Ortho Women’s and Health – Consulting Fees: Boston Scientific CFPC CoI Templates: Slide 1
  2. 2. 5/23/2014 2 Disclosure of Commercial Support • This program has received no financial support • This program has received no in-kind support • Potential for conflict(s) of interest: – None CFPC CoI Templates: Slide 2 Mitigating Potential Bias • Not applicable. CFPC CoI Templates: Slide 3
  3. 3. 5/23/2014 3 OBJECTIVES • List 3 medications that can precipitate AUR • Describe how MS can cause AUR • Describe how alpha-blockers and 5AR reduce AUR • List two indications for Urology referral INTRODUCTION • AUR most significant complication of BPH • AUR accounts for 25-30% of indications for TURP • AUR is poorly defined • Multiple etiologies
  4. 4. 5/23/2014 4 CLASSIFICATION • Spontaneous AUR – Due to the bladder • Bladder decompensation, neurogenic – Due to the bladder outlet • infarction, BPH, acute bacterial prostatitis, stricture • Precipitated AUR – Due to the bladder • Anesthesia, anticholinergics, pain – Due to the bladder outlet • Sympathomimetics, catheterization TAKE-HOME POINT • AUR is usually a combination of static (BPH) and dynamic (acute change)
  5. 5. 5/23/2014 5 WHO IS AT RISK? • Older males (BPH) • Middle aged females (MS) • Others (older males with a URI, or surgery) EPIDEMIOLOGY Eur Urol 2005; 47: 494 • Increases with age • Large prostate • Increased PSA • LUTS • Low Qmax
  6. 6. 5/23/2014 6 AUR DEFINITION • Inability to urinate • Increased residual volume – > 300 cc – Associated with clinical problems (pain, hematuria, UTI, renal compromise, bothersome LUTS) PRECIPITATED AUR • 40% of cases • What has suddenly changed? • Drugs (antimuscarinics, antipsychotics, narcotics, alpha sympathomimetics) • Acute change (pelvic surgery, diuresis) • Neurologic event (SCI, CVA, multiple sclerosis)
  7. 7. 5/23/2014 7 SPONTANEOUS AUR • BPH • With acute change • Catheter • Is it an acute increased in alpha sympathomimetic activity? ALFUSOZIN TRIAL UROL 2005; 65: 83
  8. 8. 5/23/2014 8 MTOPS NEJM 2003; 349: 2387-98 • N=3047 subjects • Mean followup 4.5 years • Double-blind, RCT • Placebo, doxazosin, finasteride, combination • > 50 years • AUASS 8-30 • Qmax 4-15 cc/sec • Exclusions: prior surgery, SBP<90, PSA>10 MTOPS NEJM 2003; 349: 2387-98 • Primary: clinical progression – AUASS 4 points – AUR – Renal insufficiency – Recurrent UTI – incontinence • Secondary: AUASS, Qmax, PSA, surgery
  9. 9. 5/23/2014 9 MTOPS NEJM 2003; 349: 2387-98 MTOPS NEJM 2003; 349: 2387-98 0 10 20 30 40 50 60 70 80 90 Age White PVR Placebo Doxazosin Proscar Combo
  10. 10. 5/23/2014 10 MTOPS NEJM 2003; 349: 2387-98 CLINICAL PROGRESSION
  11. 11. 5/23/2014 11 AUR MTOPS YEAR 4
  12. 12. 5/23/2014 12 DUTASTERIDE BMJ 2013; 346: 2109 • 1617 subjects • Placebo vs dutasteride • 4 years • Clinical progression (4 pt, AUR, UTI, surgery) TAKE HOME POINT Eur Urol 2006; supp 5: 628 • Size matters! • AUR more likely for large prostate • AUR risk increases as age and size increase • Highest risk for men with large prostates • 81% risk reduction of AUR combo, 68% risk reduction finasteride alone
  13. 13. 5/23/2014 13 DUTASTERIDE BASELINE DUTASTERIDE
  14. 14. 5/23/2014 14 REDUCE NEJM 2010; 362: 1192 • N=6729, 4 years, 50-75, biopsy negative • RCT double blind • Prostate cancer incidence reduced 23% • AUR incidence reduced 77% • Gleason 8-10 controversy TAKE HOME • AUR risk reduction 80% on dutasteride • Benefits continue for up to 4 years
  15. 15. 5/23/2014 15 WATCH OUT FOR… • MS variable presentation • 10% of women with MS present with acute voiding dysfunction • 10-30% of MS patients present with AUR or impaired bladder emptying • Prostate cancer • Bladder CIS • Hematuria and unresolved AUR warrant Urology referral! STRATEGY AUR Catheter Reduce precipitants Alpha blockers Successful voiding Alpha-blockers 5AR No neurologic BPH TURP Neurologic Confounding Urodynamics

×