A rare cause of acute urinary retention in a young man: A median raphe penile cyst

@#Background: A penile median raphe cyst is an uncommon congenital lesion that is formed due to failure of the median raphe to close completely during embryo development. The majority of the cysts are asymptomatic and often go unnoticed. Here, we report acute urinary retention as a very rare complication of a penile median raphe cyst. Case presentation: A 21-year-old single man presented with a sudden onset of acute urinary retention of one days’ duration. Urethral catheterization was done at the Emergency Department and this drained 800 ml of urine. On further questioning, he claimed that he had had a painless nodule at the glans penis since childhood. The swelling increased in size in the past week causing discomfort. He denied any history of genitalia trauma or recent sexual intercourse. On examination, there was a bluish lesion over the ventral aspect of the glans penis measuring about 3 x 2 cm. The lesion was later excised and histopathology revealed a median raphe cyst of the penis. Conclusion: A penile median raphe cyst is a rare lesion. Acute urinary retention caused by this lesion is very rare.

Postoperative acute urinary retention in anorectal diseases treated with acupuncture combined with grain-moxibustion: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the efficacy differences between acupuncture combined with grain-moxibustion and acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases.@*METHODS@#A total of 60 patients were randomized into an acupuncture combined with grain-moxibustion group and an acupuncture group, 31 cases in each one. In the acupuncture group, acupuncture was applied at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6), Shuidao (ST 28), Pangguangshu (BL 28), Sanyinjiao (SP 6) and Yinlingquan (SP 9). In the acupuncture combined with grain-moxibustion group, grain-moxibustion was given at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6) and Shuidao (ST 28) on the basis of acupuncture. Those who failed to urinate 60 min after the first treatment received the second treatment. 30 min after the second treatment, the lower abdominal symptom scores before and after treatment as well as the bladder residual urine volume after the first urination after treatment were compared between the two groups. In addition, the clinical efficacy and security were evaluated.@*RESULTS@#Compared before treatment, the symptom scores after treatment were reduced in the two groups (<0.05), and the score in the acupuncture combined with grain-moxibustion group was lower than that in the acupuncture group after treatment (<0.05). The bladder residual urine volume in the acupuncture combined with grain-moxibustion group was (26.71±17.01) mL, which was lower than (35.32±20.76) mL in the acupuncture group (<0.05). The total effective rate was 93.5% (29/31) in the acupuncture combined with grain-moxibustion group, which was superior to 71.0% (22/31) in the acupuncture group (<0.05).@*CONCLUSION@#The efficacy of acupuncture combined with grain-moxibustion is superior to simple acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases, which is safe and reliable.

Pharmaceutical Care for a AECOPD Patient with Benign Prostatic Hyperplasia and Bronchodilators-in-duced Acute Urinary Retention / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists on drug therapy for acute exacerbations of chronic ob-structive pulmonary disease(AECOPD)patients with benign prostatic hyperplasia(BPH). METHODS:Clinical pharmacists partici-pated in drug therapy for a AECOPD patient with BPH. According to clinical guideline and relevant literatures,based on the history of disease,the characteristics of bronchodilators and the symptoms of acute urinary retention,it was suggested to stop taking Ip-ratropium bromide solution for inhalation but receive Finasteride capsules 5 mg,po,qd,to reduce prostate volume and improve ob-struction+Terazosin hydrochloride tablets 2 mg,po,qd,to relax urethral smooth muscle;the occurrence of ADR was monitored closely. Salmeterol xinafoate and fluticasone propionate powder for inhalation was suggested and medication guidance for patients af-ter discharge was given by clinical pharmacists. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The pa-tient was stable and had no dysuria. The patient was allowed to leave the hospital with drugs. CONCLUSIONS:Rational use of bronchodilators is directly related to the remission of clinical symptoms and prognosis in AECOPD patients. In view of patient's dis-ease history,drug characteristics and clinical symptoms,clinical pharmacists point to possible risks of anticholinergics use,and as-sist physicians to formulate and adjust therapy plan so as to guarantee the safety and effectiveness of drug use.

The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention / 亚洲男科学杂志(英文版)

In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR). We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR (n = 348) and non-AUR groups (n = 778). After the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P < 0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P < 0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P < 0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3-12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.

Changes in plasma levels of D-dimer in patients with prostate hyperplasia complicated with acute urinary retention and its clinical significance / 国际检验医学杂志

Objective To investigate changes in plasma levels of D-dimer in patients with prostate hyperplasia(BPH)complicat-ed with acute urinary retention(AUR),and to explore its clinical significance.Methods 102 cases of patients with prostate hyper-plasia complicated with acute urinary retention,treated in this hospital from July 2013 to December 2014,were selected and divided into the simple BPH group(56 cases)and BPH complicated with AUR(BPH+AUR)group.The plasma levels of D-dimer of these patients were detected and comparatively analysed.Results Compared with the simple BPH group,the plasma levels of D-dimer of patients in the BPH+AUR group was increased,had statistically significant difference.(P <0.01).Conclusion The plasma levels of D-dimer in patients with BPH complicated with AUR increase significantly,which indicates that patients are with secondary in-creased fibrinolytic activity.Measures should be taken to relieve urinary retention as soon as possible,so as to protect the vascular endothelial function of patients and reduce the incidence of complications.

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

Effect of different durations of overdistention on rat bladder function and morphology

We investigated the contribution of the duration of overdistention (DOD) to rat bladder function and morphology and explored its possible molecular mechanisms. Bladder overdistention was induced in male Sprague-Dawley rats (200-250 g) by an infusion of saline. Forty rats were divided into 5 groups submitted to different DOD, i.e., 1, 2, 4, and 8 h, and control. Bladder function was evaluated by cystometry. Morphological changes were observed by light and transmission electron microscopy. Compared to control (44.567 ± 3.472 cmH2O), the maximum detrusor pressure of groups with 2-, 4- and 8-h DOD decreased significantly (means ± SEM): 32.774 ± 3.726, 31.321 ± 2.847, and 29.238 ± 3.724 cmH2O. With the increase of DOD, inflammatory infiltration and impairment of ultrastructure were more obvious in bladder tissue. Compared to control (1.90 ± 0.77), the apoptotic indexes of groups with 1-, 2-, 4-, and 8-h DOD increased significantly (6.47 ± 2.10, 10.66 ± 1.97, 13.91 ± 2.69, and 18.33 ± 3.28%). Compared to control (0.147 ± 0.031/0.234 ± 0.038 caspase 3/β-actin and Bax/Bcl-2 ratios), both caspase 3/β-actin and Bax/Bcl-2 ratios of 1-, 2-, 4-, and 8-h DOD increased significantly (0.292 ± 0.037/0.508 ± 0.174, 0.723 ± 0.173/1.745 ± 0.471, 1.104 ± 0.245/4.000 ± 1.048, and 1.345 ± 0.409/8.398 ± 3.332). DOD plays an important role in impairment of vesical function and structure. With DOD, pro-apoptotic factors increase and anti-apoptotic factors decrease, possibly contributing to the functional deterioration and morphological changes of the bladder.

Imperfuração himenal: a importância do diagnóstico precoce / Imperforate hymen: the importance of early diagnosis

Relata-se um caso de imperfuração himenal diagnosticado na adolescência. Estabelece-se a importância do diagnóstico precoce. Informa-se que toda adolescente com amenorreia, dor abdominal, tumor palpável na região hipogástrica e com retenção urinária aguda pode ter o diagnóstico de imperfuração himenal. Reitera-se que o exame dagenitália externa deve ser feito de rotina.

The authors report a case of imperforate hymen diagnosed in adolescence. The importance of early diagnosis is established. The paper advises that all adolescents with amenorrhea, abdominal pain, palpable tumors in the hypogastric region and with acute urinary retention may have a diagnosis of imperforate hymen. It also reiterates that theexamination of the external genitalia should routinely be made.

A Case of Imperforate Hymen with Acute Urinary Retention

Imperforate hymen is, with an incidence of 0.1%, a rare female anomaly, which can appear with symptoms such as lower abdominal pain, primary amenorrhea, dysuria, anuria, caused by retention of menstrual blood after the onset of menstruation. Generally urinary retention is caused by psychological conditions, drug effect, infection or congenital anomaly causing acute urinary obstruction. We experienced a patient with symptoms of acute urinary retention, suggesting acute urinary obstruction. The cause for the retention turned out to be an imperforated hymen, which should therefore be mentioned in the literature as a possible cause in cases suspected of urinary retention.

Acute Urinary Retention due to Aseptic Meningitis: Meningitis-Retention Syndrome / 대한배뇨장애요실금학회지

Acute urinary retention in aseptic meningitis is rarely encountered, and the diagnosis of aseptic meningitis may be less than straightforward, because its symptoms and neurological signs are occasionally mild or absent. We report a case in which acute urinary retention provided an appropriate indication for the diagnosis of aseptic meningitis as the cause of an undiagnosed fever.

Female Acute Urinary Retention Caused by Urethral Diverticulum

We report two cases of acute urinary retention in women with urethral diverticulum. Cystoscopy were performed all patients. But diverticular opening was not found. All patients failed voiding by a bladder outlet obstruction. In one case, bladder outlet obstructive symptom resolved completely after the surgical removal of the diverticulum. In another case, patient refused operation.

Acute Urinary Retention due to Urethral Foreign Bodies

A 54-year-old man presented to the emergency department with a chief complaint of suprapubic pain and inability to void for 1 day after self insertion of urethral foreign bodies. These foreign bodies were two beans self inserted compulsively into the urethra by the patient. On physical examination, two materials of oval shape in the bulbous urethra were palpable. Retrograde urethrogram showed a complete obstruction in the bulbous urethra. When possible, endoscopic removal should be used for urethral foreign bodies. However the beans of our case required surgical retrieval. We present a case of foreign bodies in the urethra with brief review of literature. To our knowledge, this is the first case of acute urinary retention due to beans in Korean literature.

Changes of XOD activity induced by acute urinary retention in rats / 第三军医大学学报

Objective To study the changes of xanthine oxidoreductase(XOD) activity induced by acute urinary retention(AUR) in rats and its significance.Methods Twenty-eight female Wistar rats were used to establish acute urinary retention model by filling bladder with 2fold bladder volume and maintaining for 2 h.Cystometry,XOD activity and malondialdehyde(MDA) concentration assays were performed at the end of over-distention and 1 h,2 h,3 h,4 h after emptying respectively.The effect of superoxide dismutase(SOD) was observed by injecting 500 U SOD into the left cardiac ventricle of 7 model rats 10 min before emptying.Another 7 rats were filled with normal bladder volume as controls and underwent filling cystonetry.Results The frequency of detrusor over-activity increased more obviously after emptying than during over-distention.XOD activity increased obviously during over-distention period as compared to controls,reduced 1 h after emptying,then increased again 2 h after emptying,finally down to normal level slowly.The concentration of MDA increased during over-distention and early period after emptying and peaked at 1 h after emptying and then recovered slowly.After SOD treatment,the frequency of detrusor over-activity,XOD activity and MDA concentration reduced as compared with that in model rats 2 h after emptying(P

Availability of Cystometrogram as a Predictive Factor of Recurrence of Acute Urinary Retention by Benign Prostatic Hyperplasia

PURPOSE: We evaluated the value of cystometrogram (CMG) as a predictive factor of recurrence of acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: 26 patients attending the emergency room or out patients clinic with AUR were assessed. Indwelling catheter was placed in the bladder for 7 days and CMG was performed within 24 hours and 7 days later of AUR. Recurrence was evaluated by medical records or telephone interview after 1 year of AUR. RESULTS: CMG findings performed just after AUR were normal (7), decreased capacity (12), large capacity (4), detrusor overactivity (2) and poor compliance (1). These findings were changed by 7-days-inwelling catheterization. Decreased capacity (12) was changed to normal in 5, unchanged in 7. Large capacity (4) were changed to normal in 3, unchanged in 1, detrusor overactivity (2) and poor compliance (1) were unchanged. AUR was recurred in 5 (33.3%) out of 15 patients who showed normal (7) and turned to normal after 7-days-indwelling catheterization (8), but in 7 (63.6%) out of 11 patients whose CMG was not changed by 7-days-indwelling catheterization. CONCLUSION: Patients who showed normal at initial CMG and turned to normal CMG after 7-days-indwelling catheter were at low risk of recurrence of AUR. Therefore, CMG performed at the time of AUR may be helpful in the prediction of recurrence of AUR.

The Predictors of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Acute urinary retention is one of the most severe complications in patients with benign prostatic hyperplasia (BPH). We investigated the efficacy of age, International Prostatic Symptom Score (I-PSS), quality of life (QOL) score and various parameters obtained by transrectal ultrasonography (TRUS) as predictors of acute urinary retention. MATERIALS AND METHODS: Of 153 patients with BPH, who underwent transurethral resection of the prostate, 72 were treated due to acute urinary retention (retention group) and 81 due to lower urinary tract symptoms (symptomatic group). TRUS was used to calculate the total prostate (TP) and transitional zone (TZ) volumes, the transitional zone index (TZ index=TZ volume/TP volume) and the elongation ratio (ER=the ratio of the maximal anteroposterior to transverse diameter of the prostate). To compare the usefulness of various parameters between the retention and symptomatic groups, the area under the receiver-operating characteristic (ROC) curve was calculated for each parameter. RESULTS: There were significant differences in the TP and TZ volumes, the TZ index and the elongation ratio between both groups, but no significant differences in age, I-PSS or QOL score. In the retention group, the most effective cutoff values were 40cc, 20cc, 0.55 and 0.75 for the TP volume, the TZ volume, the TZ index and the elongation ratio, respectively. The area under the ROC curves were 0.894, 0871, 0843 and 0771 for the TZ index, the elongation ratio, the TZ volume and the TP volume, respectively. CONCLUSIONS: The TP and TZ volumes, the TZ index, and the elongation ratio are useful predictors of acute urinary retention in patients with BPH. The TZ index is the most useful predictor, and may be a useful parameter in selecting the treatment for BPH.

Transitional Zone Index: a Predictor of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To investigate the efficacy of age, International Prostate Symptom Score(I-PSS), quality of life(QOL) score, various parameters obtained by transrectal ultrasonography(TRUS) as predictors of the onset of acute urinary retention in patients with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: From January 1996 to December 1997, 101 men(mean age 70years, range 52-92) with symptoms of BPH were enrolled in this study. Among them, 36 patients had suffered from acute urinary retention. TRUS was used to calculate the total prostate(TP) volume, the transitional zone(TZ) volume, the transitional zone index(TZ index=TZ volume/TP volume). To compare the usefulness of various indices, the area under the receiver-operator characteristic(ROC) curve was calculated for each index. RESULTS: There were significant differences in age, TP volume, TZ volume, TZ index between patients with and without acute urinary retention, but no significant differences in I-PSS and QOL score. In patients with acute urinary retention, the area under the ROC curve was 0.911 for the TZ index, 0.892 for the TZ volume, 0.769 for the TP volume and 0.660 for the age. CONCLUSIONS: The TZ index is a useful predictor of acute urinary retention in patients with BPH and may be a useful parameter for decision of surgical intervention.

The Etiology and Management of Female Urinary Retention / 대한비뇨기과학회지

The incidence of acute urinary retention in females is very low but the causes are diverse. So, it is important to verify the causative diseases trough history taking, physical examination including neurologic tests and it is essential to find adequate therapeutic modalities. MATERIALS AND METHODS: We experienced 45 female patients who visited under the chief complaint of acute urinary retention and reviewed, evaluated retrospectively or prospectively during 4 years. The patients are divided 1) transient causes: immobilization after surgery, constipation, medications, herpes zoster, psychogenic causes 2) neurologic causes: cerebral concussion, peripheral neuropathy, brain tumor, herniated nucleus pulposus, spinal cord injury, previously undiagnosed diabetes 3) pelvic causes: difficult labor, uterine prolapse,, pelvic bone tumor, vaginal invasion of rectal cancer, imperforate hymen. RESULTS: Screening test were done through physical examination, history taking, routine urinalysis. Most patients recovered voiding after correction of underlying diseases. CONCLUSIONS: The patients who showed persistent retention were further evaluated through neurologic tests, urodynamics, pelvic ultrasonography and serious diseases as blain tumor, polyneuritis, metastaic pelvic bone tumor were diagnosed.

The usefulness of rapid injection cystometry in the patients with acutely overdistended bladder / 대한비뇨기과학회지

It is known that if the detrusor integrity is maintained, a single coordinated sustained contractile relaxation curve can be observed on rapid injection cystometry in the paralytic period after overdistention, but there is no study on its clinical significance. This study is to know the diagnostic usefulness of such relaxation curve in assessing the possibility of the voiding function recovery in the paralytic period after overdistention. We performed rapid injection cystometrys in 12 patients who had no contraction and sense on medium injection cystometry until 450ml infusion after non-neurogenic acute urinary retention by various causes, and compared the duration for recovery and the presence or absence of a single coordinated sustained contractile relaxation curve, the bladder volume at the first time of such a relaxation curve and the maximum pressure of contraction curve. The results were as follows; 1. All of 3 patients without a single coordinated sustained contractile relaxation curve did not recover their voiding function until three months after overdistention. 2. All of 9 patients with single coordinated sustained contractile relaxation curve recovered their voiding function within four weeks. 3. In 9 patients who recovered their voiding function, the smaller the bladder volume at the first such relaxation curve, the shorter the duration for recovery(r=0.69767. p=0.036), but there is no relationship between the maximum pressure of contraction curve and the duration for recovery(r=-0.10192, p=0.794). In conclusion, rapid injection cystometry is a useful clinical test to check the possibility of voidingfunction recovery within a few weeks in the paralytic period after acute overdistention.

The recovery of the destusor muscle function in acute urinary retention patients due to benign prostatic hyperplasia / 대한비뇨기과학회지

We studied 33 patients with acute urinary retention due to benign prostatic hyperplasia for evaluating the recovery of the detrusor muscle function and its affecting factors through the serial urodynamic studies prospectively. And ninety nine patients were studied for risk factors of acute urinary retention retrospectively. Among the 33 patients studied prospectively, detrusor contraction at immediate decompression was observed in 20 cases(60.7%) and was not observed in 13 cases (39.3%), and there was statistically significant difference in the retained volume and duration of retention between two groups. In 10 cases of non-contraction group at immediate decompression, serial urodynamic studies showed that detrusor contraction recovered within 2 days in 4 cases, but in 6 cases no detrusor contraction was found upto 5 days. Overall, detrusor function recovered in 80% or patients within 2 days. Among the patients studied for risk factors, hesitancy and interruption were the most common symptoms whereas urgency and urge incontinence were the least common. In conclusion, it is thought that acute urinary retention due to benign prostatic hyperplasia is resulted from temporary or permanent loss of detrusor muscle function due to overdistension, and the degree of retention duration and retained volume expressly affect the severity of loss of detrusor muscle function. The risk of acute urinary retention is higher in benign prostatic hyperplasia patients with obstructive symptoms rather than irritative symptoms.

A Case of Imperforated Hymen Associated with Acute Urinary Retention / 대한비뇨기과학회지

Failure in the formation of a hymeneal orifice is a rare congenital malformation. There are many cases of imperforated hymen with hematocolpos in literature. However this condition associated with obstructive uropathy such as acute urinary retention is rare. We experienced a case of imperforated hymen with hematocolpos which caused acute urinary retention in a 16-year-old girl. Herein we report this case with brief review of literature.