High pressure chronic retention: a life-threatening clinical entity.

OBJECTIVES: To report our experience with high pressure chronic retention (HPCR), a clinical syndrome with potentially disastrous consequences. DESIGN: A prospective hospital based descriptive study. Setting A urology unit at the National Hospital of Sri Lanka, Colombo. Patients Forty seven consecutive new patients with HPCR evaluated during a 2-year period. RESULTS: Of the 47 (39 male) patients, 15 (32%) were below 50 years of age. Nocturnal enuresis was encountered in 32 (68%) patients, and a tense, non-tender distended bladder found in all 47 patients. Hypertension was recorded in 25.5% of the patients. Bilateral hydroureteronephrosis was detected on ultrasonography in nearly 80% of the patients, and renal impairment was found in 20 (42.5%). The mean retained volume was 968 mL. Seven (15%) patients developed post-obstructive diuresis. Eight women (mean age 47.5 years, range 30-70 years) had HPCR. Four had no obvious cause. Six (75%) had adult onset nocturnal enuresis. Renal impairment was found in four (50%) patients. Post-obstructive diuresis was recorded in two women. CONCLUSIONS: HPCR, a clinical entity known to affect the elderly in the West, was found to affect a relatively young patient group in Sri Lanka. The symptom of adult-onset nocturnal enuresis should alert the clinician to the possibility of HPCR. Renal failure is common at initial presentation. Urethral catheterization could lead to life-endangering diuresis. We describe eight women with this entity, hitherto unreported in the medical literature.

Haematuria as the presenting symptom: experience from a tertiary referral centre in Sri Lanka.

OBJECTIVES: To examine the causes of macroscopic (gross) haematuria in patients where it is the main presenting symptom and to evaluate the role of cystoscopy in their investigation. DESIGN: Prospective audit. SETTING: One urology unit at the National Hospital of Sri Lanka, Colombo. PATIENTS: 174 consecutive new patients with macroscopic haematuria, where haematuria was the presenting symptom. OUTCOME MEASURES: Causes of macroscopic haematuria in the under 40 years and over 40 age groups; role of cystoscopy. RESULTS: Of the 156 (130 male and 26 female) patients evaluated for macroscopic haematuria 67 were under the age of 40 years and 89 over 40. The causes of macroscopic haematuria in the under 40s in descending order of frequency are urinary stone disease, idiopathic and inflamed urothelium. In the over 40 group bladder cancer was the commonest cause, affecting 31.5% of patients, followed by stone disease. CONCLUSIONS: Macroscopic haematuria in a patient over the age of 40 years could be due to bladder cancer and merits cystourethroscopy. In younger patients, urolithiasis is the predominant cause.

An audit of the surgical work-load in a urology unit.

OBJECTIVES: To assess the surgical work-load on a urology unit; to define the difference between case-load and work-load; and to assess the work-load in relation to surgical staffing levels. DESIGN: Prospective audit of all surgical procedures carried out on patients, excluding extracorporeal shockwave lithotripsy (ESWL), during a one year period, classified according to the British United Provident Association (BUPA) schedule of procedures. SETTING: One of the two urology units at the National Hospital of Sri Lanka, Colombo (NHSL). PATIENTS: Inpatients having surgical procedures in one year. MAIN OUTCOME MEASURES: The number of surgical procedures, according to their complexity, with particular reference to the level of surgical staffing; difference between case-load and the actual work-load computed using the Intermediate Equivalent (IE) system of Jones and Collins (1). RESULTS: The annual surgical work-load on the urology firm was 1900 IEs. In our unit BUPA complex major, major plus and major operations comprised 27.2% of the case-load but accounted for about 47% of the work-load. The BUPA intermediate and minor procedures comprising the remaining 72.8% of the case-load accounted for only 53% of the work-load. Endoscopic urological procedures made up 71% of the work-load. The specialist surgeon and the senior registrar have contributed to 51.4% (977 IEs) and 40.2% (765 IEs) of the total work-load respectively. CONCLUSION: Case-load is a poor performance indicator of surgical activity. IE weighted work-load has been shown to reflect surgical activity more appropriately than case-load. A well trained senior registrar's contribution to the total surgical work-load is appreciable.