Low Incidence of Acute Urinary Retention in the General Male Population: The Triumph Project
Introduction
Acute urinary retention (AUR) is a condition characterized by a sudden inability to urinate, which is usually extremely painful and requires catheterization [1].
The causes of AUR can be classified into three categories. The first relates to any event that increases resistance to the urinary flow such as benign prostatic hyperplasia (BPH) [2]. AUR is an important complication of BPH and the reason for surgery in 25 to 30% of patients undergoing prostatectomy [3].
Secondly, AUR may result from an interruption of either the sensory innervation of the bladder wall or weakness of the detrusor muscle [2]. The third category relates to any situation that permits the bladder to over-distend (e.g. post-surgery, drugs) [2].
The reported cumulative incidence estimates of AUR in males vary widely from 0.4% to 25% per year. This variation is related to differences in design, population (e.g. clinical trials versus cohort studies) and age distribution and differences in the case definition of AUR [4], [5].
The incidence of AUR in the general male population has been studied in two large population-based studies in the US but information in Europe is only available from a small cohort study following 456 men over 5 years [3], [6], [7]. We therefore aimed to assess the incidence rate of AUR in a large Dutch male population and to compare it to the incidence rate in patients newly diagnosed with lower urinary tract symptoms suggestive of BPH (LUTS/BPH).
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Setting
This study was conducted in the Integrated Primary Care Information (IPCI) database in The Netherlands. IPCI is a general practice research database, containing information from electronic patient records of 150 GPs covering a total of 500,000 patients. The demographic characteristics of the population of the IPCI database are in accordance with the formal national registry CBS (central bureau of statistics) (statline.cbs.nl).
In the Dutch health care system, all persons are registered with a
Results
The total study cohort comprised 56,958 males with a mean age of 58 years. At study-entry, 4680 patients (8%) had a prior history of LUTS/BPH, the prevalence of diabetes mellitus was 4% and more than 70% of subjects had no chronic co-morbidity (Table 1).
After validation, 344 patients were classified as having AUR, 244 (59%) had a history of LUTS (storage, voiding or postmicturition symptoms) prior to AUR; 149 of the 344 patients belonged to the incident LUTS/BPH cohort. Although the actual
Discussion
This population-based cohort study showed that AUR is uncommon in a general male population of 45 years and older. Within the cohort of men newly diagnosed with LUTS/BPH, AUR is the first presenting symptom of BPH in approximately 50% of all AUR cases. The age-adjusted hazard of AUR was about 11-fold higher in men newly diagnosed with LUTS/BPH than in the general male population.
Our overall incidence is somewhat lower than the incidence of AUR reported in 2 US cohort studies; the Health
Acknowledgements
The Triumph Project is supported by an unconditional grant from Yamanouchi Europe.
We thank the Triumph Pan European Expert Panel and Mr. David Williams for their help in the review of the article.
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