Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:
1. In the Epidemiology section, we suggest adding: "Urinary retention in females is uncommon, occurring 1 in 100,000 every year, with a female-to-male incidence rate of 1:13.[1] It is usually transient and quite clinically ill-defined in some cases. The causes of UR in women can be multi-factorial, and can be postoperative and postpartum. Prompt urethral catherization usually resolves acute emergency UR.[1]"
2. Add a section called “postoperative urinary retention risk factors” and add the following information:
Postoperative urinary retention risk factors: age, medications, anesthetics, benign prostatic hyperplasia/lower urinary tract symptoms, and surgery related factors, including operating room time, intravenous fluids, and procedure type.[2][3][4][5][6][7][8]
Age:
Older patients can suffer from degeneration of neural pathways involved with bladder function and it can be responsible for the increased risk of postoperative urinary retention.[2][3]The risk of postoperative urinary retention increases up to 2.11 fold for patients older than 60 years.[2][3]
Sex:
Another risk factor is sex. It has been shown that sex increases risks for urinary retention not related to surgery given.[3] For men, benign prostatic hyperplasia increases risk, due to the fact that it’s a risk factor for lower urinary tract dysfunction and retention.[4] This association has not been as strongly elucidated for postoperative urinary retention.[3][4][5]
Medications:
The following medications are associated with increased risks of postoperative urinary retention: anticholinergics and medications with anticholinergic properties, alpha-adrenergic agonists, opiates (The incidence of opioid precipitated retention in the postoperative setting has been found to be as high as 25%.[6]), nonsteroidal antiinflammatories (NSAIDs) (up to 2 fold.[7]), calcium-channel blockers and beta-adrenergic agonists.[8]
Anesthesia:
General anesthetics can cause bladder atony by acting as smooth muscle relaxants.[3][4] In addition to that, it can directly interfere with autonomic regulation of detrusor tone and predispose patients to bladder overdistention and subsequent retention.[3][4] On the other hand, spinal anesthesia results in a blockade of the micturition reflex.[3][4] Overall, spinal anesthesia shows a higher risk of postoperative urinary retention compared to general anesthesia.[3][4]
Benign prostatic hyperplasia:
Men with benign prostatic hyperplasia are at an increased risk of acute urinary retention.[2] This finding is supported by a meta-analysis of 570 articles. It was established that lower urinary tract symptoms were significantly associated with an increased risk of urinary retention (OR 2.83).[2]
Surgery related:
Operative times longer than 2 hours increased the risk of postoperative urinary retention 3-fold.[3]17 Longer surgery times increase patients’ risks of urinary retention. A rule of thumb suggests that for operative cases lasting longer than 3 hours, a Foley catheter should be inserted preoperatively.[8] Overall, there is a theory that longer operative times, increased amounts of IV fluids, and higher doses of anesthetics and opiates likely all together increase risks of postoperative urinary retention.[8]
- Please make sure you are consistent with the citations. There are no spaces between citations, and the citation is placed immediately after the punctuation, with no extra spaces. See "age" and double check others.JenOttawa (talk) 03:50, 15 November 2017 (UTC)
3. We suggest describing the pathophysiology of chronic urinary retention in a concise manner.
Chronic urinary retention that is due to bladder blockage which can either be as a result of muscle damage or neurological damage.[9] If the retention is due to neurological damage, there is a disconnect between the brain to muscle communication, which can make it impossible to completely empty the bladder.[9] If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.[9]
- Can you reword: "thereby inhibiting complete voiding of the bladder" to user simpler language?JenOttawa (talk) 03:50, 15 November 2017 (UTC) - did it
"The most common cause of chronic urinary retention is BPH. [10] BPH is a result of the ongoing process of testosterone being converted to dihydrotestosterone which stimulates prostate growth.[11] Over a person's lifetime, the prostate experiences constant growth due to the conversion of testosterone to dihydrotestosterone.[11] This can cause the prostate to push on the urethra and block it, which can lead to urinary retention.[11]
- Can you add a few wikilinks to testosterone and dihydrotestosterone?JenOttawa (talk) 03:50, 15 November 2017 (UTC) did it!
- "Over a person's lifetime" may work better here. Change obstruct to "block"? There may be other ways to simplify this last sentence as well.JenOttawa (talk) 03:50, 15 November 2017 (UTC) - did it!
4. In the treatments section, we suggest that we replace the New York Times citation[12] with an peer-reviewed paper.
- Which citation are you using instead? Any change to the text?JenOttawa (talk) 03:50, 15 November 2017 (UTC)
- @Craig.rodrigues19: The link to this nytimes citation is not working for me, it skips to the general https://www.nytimes.com/section/well website and I am not able to view the article. I also noticed that this was already used in the Wikipedia article, and moved your content into the catheterization section. The previous link was also broken. Please adjust so we can read your reference. Thanks!JenOttawa (talk) 18:13, 23 November 2017 (UTC)
Additionally, we suggest adding the following information in regards to self-catheterization such as: "Urinary retention combined with recurrent or chronic urinary tract infection may require continued intermittent self-catheterization as this has been shown to reduce infection.[13] While clean Intermittent self catheterization (CISC) is currently the gold standard for patients with urinary retention--and has a lower infection risk compared to catheterization that stays within the body; however, there can be challenges with compliance for intermediate catheterization. For example, with older demographics, who are incapable or lack the dexterity for self catheterization.[14]
- replace "patients" with "people"JenOttawa (talk) 03:50, 15 November 2017 (UTC)
- Suggestion:Intermittent self catheterization (CISC) is the preferred catheterization approach for people with urinary retention.(ref) CISC has a lower infection risk compared to catheterization techniques that stays within the body.(ref) Challenges with CISC include compliance for intermediate catheterization as some people may not be able to place the catheter themselves.(ref)
- What is intermediate catheterization? You may need to define this. My suggestion is just an example of a way to simplify the information and include references at the end of each sentence. You may modify it as you see fit and according to your evidenceJenOttawa (talk) 03:50, 15 November 2017 (UTC)
5. Add the following to the diagnosis section:
"Non-neurogenic Chronic Urinary Retention does not have a standardized definition, but urine volumes >300mL can be used as an informal indicator of chronic urinary retention.[9] The retention has to be present for a period of time greater than 6 months, that is to say, 2 separate measurements of urine volume 6 months apart should have a PVR (post-void residual) volume of >300mL.[9] CUR can be caused by bladder outlet obstruction and/or an underactive bladder (detrusor underactivity).[9]
6. In the first paragraph of the treatment section of the article, there is a sentence that states, “5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal”. However, the citation for this statement actually indicates that alpha blockers, not alpha-reductase inhibitors, increase the chance of normal urination following catheter removal. As such, we would suggest amending the statement to say, “Use of alpha-blockers can provide relief of urinary retention following de-catheterization for both men and women.[15][16]”
Thank you very much for taking time to provide us with feedback.
(Sunavsky (talk) 14:39, 1 November 2017 (UTC))
- COMMENTS: Your proposed ref #10 "Urinary Retention" is already ref #1 in the article. "Postoperative risk factors" might be better as a sub-section under Causes. You create a sub-section by putting === before and after the text. Under that, it might be better to collapse the short sections you outlined (age, medications, anesthetics, benign prostatic hyperplasia/lower urinary tract symptoms, surgery related) as sentences following the introductory sentence. And remove the ones that are not postoperative. Beyond the scope of your assignment, but that long list that is already in Causes is woefully lacking in citations, as are other sections. David notMD (talk) 04:29, 8 November 2017 (UTC)
References
Özveren, B; Keskin, S (2016). "Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients". Urology annals. 8 (4): 444–448. doi:10.4103/0974-7796.192111. PMID 28057989.{{cite journal}}: CS1 maint: unflagged free DOI (link) "Urinary Retention". National Institute of Diabetes and Digestive and Kidney Diseases. Aug 2014. Archived from the original on 4 October 2017. Retrieved 31 October 2017. Herati, AS; Kohn, TP; Butler, PR; Lipshultz, LI (June 2017). "Effects of Testosterone on Benign and Malignant Conditions of the Prostate". Current sexual health reports. 9 (2): 65–73. doi:10.1007/s11930-017-0104-7. PMID 29056882.
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): LebronGOAT, Craig.rodrigues19, Sunavsky. Peer reviewers: LebronGOAT.