A comparative study between patients with acute urinary retention and without retention to determine predictors of acute urinary retention in benign prostatic hyperplasia

Abstract

INTRODUCTION: The natural history of Benign Prostatic Hyperplasia(BPH) is variable. One of the most significant complications that a patient with Benign Prostatic Hyperplasia can experience is Acute urinary retention (AUR).Benign Prostatic Hyperplasia is a progressive disease. This concept is being slowly accepted. Acute Urinary Retention is one of the long-term outcomes of benign prostatic hyperplasia. The exact incidence rates of acute urinary retention was uncertain till the recent past. However with the availability of population-based studies of community-dwelling men as well as those from patients diagnosed with BPH, better estimates of the incidence of AUR are currently available. The incidence rate per 1000 patient-years is less variable in the community than previously thought. This is the data inferred from descriptive and analytical studies. The estimated incidence rate is 5–25 per 1000 person-years. It is approximately 0.5%–2.5% per year. Risk is cumulative . It increases with an increase in age. The cumulative risk of AUR in a fifty year old male , with mild symptoms of BPH, if he lives to be 80 is about 20%. The risk of AUR for a sixty year old man who lives another twenty years is about 23%, and that for seventy year old man who lives another 10 years, is about 30%. AIM OF THE STUDY: To accurately determine factors that predict acute urinary retention in patients with benign prostatic hyperplasia by comparing patients presenting with acute urinary retention to patients without retention. MATERIALS AND METHODS: Study Group: All men presenting with LUTS, with and without retention, clinically and radiologically diagnosed to have BPH , attending urology OPD and inpatients at GKMCH and GRH beween March 2012 – Feb 2013 were included in the study. Study Design: Prospective observational analytical study. Inclusion Criteria: 1. Patients in the age group between 49-85 years. 2. Clinically and radiologically diagnosed BPH patients. 3. Patients presenting with spontaneous AUR . Exclusion Criteria: 1. Patients with post spinal injury, spinal degenerative and disc prolapse diseases. 2. Patients presenting with precipitated AUR . 3. Patients with stone disease 4. Patients with carcinoma prostate This is a prospective observational analytical study conducted at GKMCH/GRH from March 2012 to Feb 2013. The study was approved by instituitional ethical committee and all men gave written informed consent. 63 patients were enrolled in the study. Among them,32 patients presented with AUR and 31 patients presented with LUTS only. The diagnosis of BPH in all patients were confirmed clinically and radiologically. All patients age, comorbid illnessess, previous history of AUR were recorded. RESULTS We planned to compare the following factors between AUR/ nonAUR groups. 1.Age , 2.comorbid illnesses, 3. previous history of urinary retention,4. IPSS symptom severity and grading , 5. Prostate size grading as per digital rectal examination (DRE), 6. size of prostate as per ultrasound study , 7. thickness of bladder wall(BWT)by ultrasound, 8.intravesical protrusion (IPP) grading by ultrasound , 9. serum PSA level and 10.presence of urinary tract infection. In our study among the 63 patients,2 patients in AUR group (one having treatment with antidepressants, one with neurogenic bladder dysfunction) and one in non AUR group (who had biopsy confirmed carcinoma prostate) were excluded. Statistical package for social sciences, version 12.0.2 (SPSS, inc, Chicago, USA)was used for statistical analysis. level of significance was considered with the p value of < 0.05. CONCLUSION Symptom severity, previous AUR episodes, high serum PSA levels, increased size of prostate ,increased bladder wall thickness, increased intravesical prostatic projection are accurate predictors of acute urinary retention in patients with Benign Prostatic Hyperplasia. Those patients who are at risk can be offered earlier treatment options ,could be either medical or surgical intervention to prevent AUR