MANAGEMENT OF LOWER URINARY RETENTION IN A LIMITED RESOURCE SETTING

Abstract

BACKGROUND: There is a projected increase in lower urinary tract obstruction by 2018, especially inthe developing economies of Asia and Africa. However in many of these countries, the problemsencountered both by the patients and the clinicians are not well documented. Our aims are, toprospectively analyse the management of urinary retention, the associated difficulties, and complicationsin our setting, where access to investigative modalities such as Computerize Tomography and MagneticResonance Imaging are not available.PATIENTS AND METHODS: The study was approved by the University Of Calabar Teaching Hospitalethical committee. A validated Proforma was used to collect data from all patients who were clinicallydiagnosed with urinary retention based on history, and physical examination, from July 2009 to June2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findingson physical examination, previous medical history and co-morbid conditions. The results ofinvestigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenousurography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of theprostate . The total number of new patients seen, including those with urinary retention during the studywas documented. The retentions were also classified into acute and chronic. All the patients werefollowed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4of 2007 to analyse the data, estimating averages, mean, median and percentages. RESULTS: The totalnumber of new patients seen, including those with urinary retention was Seventy thousand, one hundredand thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinaryretention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.Thepatients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them werein the 6 th and 7 th decades of life. The common causes were; prostatic diseases [BPH and cancer of theprostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relievedby: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34(21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encounteredcomplications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change ofcatheter 16.8% [figure 2].CONCLUSION: Lower urinary retention is common in our environment. The management isappropriate and standard. The man power and facilities are inadequate, and requires urgentimprovement.