Better estimates of AUR incidence are now available from both population-based studies and placebo control groups patients diagnosed with BPH. Several strong risk factors for AUR have been identified by analytical epidemiology, the most important being serum PSA levels. When counseling patients with BPH procedure per vesciculite are considering watchful waiting, clinicians should also take into account prostate volume, maximum flow rate, and symptom severity.
For a variety of reasons, acute urinary retention AUR is one of the most significant complications of long-term benign prostatic hyperplasia BPH. In the past it has represented an immediate indication for surgery. For this reason alone, AUR is an important and feared event, from procedure per vesciculite economic standpoint as well as from the viewpoint of the patient.
The patient originally has inability to urinate, with increasing pain, and eventually a visit to the emergency room, catheterization, follow-up visits to the physicians, an attempt at catheter removal, and eventual recovery or surgery, procedure per vesciculite is both painful and time consuming. The etiology of AUR is poorly understood. Prostate infection, bladder overdistension, 5 excessive fluid intake, alcohol consumption, sexual activity, debility, and bed rest have all been mentioned.
Prostatic infarction has been suggested as an underlying etiologic event. In contrast, there was no evidence of infarction in six prostatectomy procedure per vesciculite removed from men who had surgery for AUR. From a clinical and prognostic point of view, spontaneous AUR should be separated from precipitated AUR, although this is by no means consistently done in the literature.
Precipitated AUR refers to the inability to urinate following a triggering event such as non-prostate-related surgery, catheterization, anesthesia, ingestion of medications with sympathomimetic or anticholinergic effects, ingestion of antihistamines, or other events. All other AUR episodes are classified as spontaneous.
The study of epidemiology involves the distribution and determinants of diseases in humans. Epidemiology can be procedure per vesciculite description of disease incidence, mortality, and prevalence by person, place, and time or analytical a search for determinants procedure per vesciculite disease risk that may serve to increase prospects for prevention. Methods of studying the natural history of BPH.
AUR is an event that takes place in the course of the natural history of the disease process. The natural history procedure per vesciculite BPH can theoretically be evaluated by studies using a variety of designs see box. Longitudinal studies of untreated cohorts of men diagnosed with lower urinary tract symptoms LUTS and clinical BPH by any definition watchful waiting cohorts. Longitudinal procedure per vesciculite of unselected ie, undiagnosed men living in the community who are less likely to progress and request or require therapy longitudinal population-based studies.
There are problems associated with all these approaches. Concerning the watchful waiting cohortsthe first question to be resolved is procedure per vesciculite or not it is ethical or feasible to procedure per vesciculite symptomatic men in such a study even if the disease studied is not fatal.
Furthermore, in the course of such a natural history study, many procedure per vesciculite men will become more and more symptomatic and will desire and receive treatment, making them procedure per vesciculite for further study participation and thus reducing the number of men available for analyses.
Concerning the incidence of AUR, data are procedure per vesciculite from population-based studies as well as from placebo control groups of BPH studies.
These data can be discussed in terms of descriptive and analytical epidemiologic approaches. Descriptive epidemiology. The self-reported rate of AUR in a crosssectional study in Spanish men was 5. More recent data from procedure per vesciculite controlled studies in better defined populations shed additional light on procedure per vesciculite incidence rates in community dwelling men and clinical BPH populations Table 1.
During 15, person-years of follow-up in the Physicians Health Study, 82 men reported an episode of AUR, for an incidence rate of 4. The placebo treatment groups from three 2-year studies with a similar patient population were meta-analyzed by Boyle and colleagues. Analytical epidemiology. Several well-controlled studies have provided considerable insight into the risk factors for AUR. In the Physicians Health Study, rates increased with age and baseline symptom severity retention.
In men with symptom scores of 8 to 35, rates increased from 3. Men with a clinical diagnosis of BPH and a symptom score of 8 or greater had the highest rates age-adjusted incidence All seven lower urinary tract symptoms comprising the American Urological Association symptom index individually predicted AUR. The sensation of incomplete bladder emptying, having to void again after less than 2 hours, and a weak urinary stream were the best independent symptom predictors.
Use of medications with adrenergic or anticholinergic side effects also predicted acute urinary retention. Incidence rates per person-years increased from 2. The relative risk increased for older men, those with moderate to severe symptoms 3. All other stratifications of men over 70 years had a relative risk RR ranging from Data from Jacobsen et al.
Procedure per vesciculite risk of AUR in Olmsted County Study by age, symptom severity, peak flow rate, and prostate volume; the red columns represent the baseline and a relative risk RR of 1. Although age in community procedure per vesciculite men is an important risk factor, in a BPH trial population of men already diagnosed with BPH, other factors can be analyzed. In the placebo groups of three 2-year studies 25 and a 4-year study PLESS1226 — 28 prostate volume, serum prostate-specific antigen PSA levels, and symptom severity were all predictors of AUR episodes.
The incidence increased from 5. An analysis of over possible outcome predictors alone or in combination revealed that a combination of procedure per vesciculite PSA, urination more than every 2 hours, symptom problem index, maximum urinary flow rate, and hesitancy were only slightly superior to PSA alone in predicting AUR episodes. The concept that this disease is in fact progressive in nature is slowly being accepted.
Although in the past uncertain estimates regarding the incidence rates of AUR existed, and almost one-third of patients presented in AUR for TURP, nowadays better estimates are available from population-based studies of community dwelling men, as well as from patients diagnosed with BPH placebo control groups.
Descriptive and analytical epidemiologic data have shown that the incidence rate per person-years is less variable in the community than previously assumed.
The best controlled studies allow for an estimate between 5 and 25 per person-years, or 0. However, this risk is cumulative and increases with advancing age. Procedure per vesciculite risk in patients diagnosed with BPH is naturally higher, and analytical epidemiology has identified several strong risk factors for AUR, the most important being procedure per vesciculite serum PSA levels.
In addition, prostate volume, maximum flow rate, and symptom severity should be considered when counseling patients presenting with LUTS and clinical BPH who are considering a course of watchful waiting.
For evaluating outcomes, it is important to distinguish between precipitating AUR which follows a triggering event and spontaneous AUR.
BPH may be evaluated by controlled studies or by longitudinal either watchful procedure per vesciculite or population-based studies. Recent data from controlled studies have given better estimates of AUR incidence rates: 5 to 25 per 1, person-years; the risk is procedure per vesciculite and increases with age. Analytical epidemiology studies show that incomplete bladder emptying, having to void again after less than 2 hours, and a weak urinary stream are the best risk predictors for AUR.
National Center for Biotechnology InformationU. Journal List Rev Urol v. Rev Procedure per vesciculite. Claus G RoehrbornMD. Author information Copyright procedure per vesciculite License information Disclaimer. Note: Dr. Roehrborn acts as an investigator with MSD, the maker of Finasteride].
This article has been cited by other articles in PMC. Key words: Acute urinary retention, Benign prostatic hyperplasia, Epidemiology, Risk factors. Studies of the behavior of men diagnosed with LUTS and BPH and enrolled in controlled studies of LUTS and BPH procedure per vesciculite groups and receiving either no treatment compared with active intervention placebo treatment compared with medical treatment sham treatment compared with device or surgical treatment Longitudinal studies of unselected ie, undiagnosed men living in the community who are less likely to progress and request or require therapy longitudinal population-based studies.
Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. References 1. Transurethral prostatectomy: practice aspects of the dominant operation in American urology.
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Br J Urol. Benign prostatic hyperplasia and its treatment [review] J Gen Intern Med. Controversies about indications for transurethral resection of the prostate [review] J Urol. Prostatic infarction. Role in acute urinary retention. Natural history of prostatism: risk factors procedure per vesciculite acute urinary retention. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years.
Characterization of patients and ultimate outcomes. Eur Urol. Serum prostate-specific antigen procedure per vesciculite is a powerful predictor of acute urinary retention and procedure per vesciculite for surgery in men with clinical benign prostatic hyperplasia.
Plymouth, UK: Plymbridge Distributors; Epidemiology and natural history of benign prostatic hyperplasia; pp. Natural history of benign prostatic hypertrophy and acute urinary retention. Natural history of prostatic obstruction. J R Coll Gen Practit. Prevalence of urinary symptoms and other urological conditions in Spanish men 50 years old or older [see comments] J Urol.