Armitage, J.N.; (2011) The epidemiology and management of acute urinary retention: a study based on Hospital Episode Statistics and systematic literature review. Doctoral thesis , UCL (University College London).

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Abstract

Acute urinary retention (AUR) is characterised by the sudden and painful inability to pass urine and is common in older men. It causes significant morbidity, frequently results in emergency hospital admission and often requires surgery. The aim of this thesis was to investigate ways of improving the management of men with AUR. The Hospital Episode Statistics (HES) database of the Department of Health was used to investigate mortality after AUR. In 100,067 men with spontaneous AUR, the one year mortality was 4.1% in men aged 45-54 and 32.8% in those aged 85 and over. In men with spontaneous AUR aged 75-84, the most prevalent age group, the one year mortality was 12.5% in men without comorbidity and 28.8% in men with comorbidity. The importance of comorbidity on mortality of men with AUR prompted the development of The Royal College of Surgeons of England (RCS) Charlson Score to improve comorbidity identification in HES. The RCS Charlson Score uses an explicit coding philosophy that is simple to use, more accurate than existing adaptations of the Charlson Score, reflects the current understanding of the prognostic impact of comorbidity and allows international comparisons. Given that many men with AUR are elderly, have significant comorbidity and therefore have a high risk of death, minimally invasive treatment alternatives to surgery for AUR were evaluated. Systematic literature review defined the role of prostatic stents as an effective treatment for frail and elderly men. Although only observational data were available a specifically developed checklist to assess methodological quality gave context to the findings. This thesis demonstrates that the management of AUR must focus not only on the prostate but also on the patient’s overall health status. The urologist should adopt a holistic approach when assessing and treating men with AUR to ensure the best possible outcomes.

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