Moul J W, Davis R, Vaccaro J A, Sihelnik S A, Belville W D, McLeod D G
Urology Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
J Urol. 1989 Jun;141(6):1375-7. doi: 10.1016/s0022-5347(17)41312-7.
We describe the prospective evaluation of 90 patients seen at 2 medical centers who presented with acute urinary retention. All patients had a pre-retention history obtained, as well as careful prostate examination, perineal prostate biopsy and followup treatment or monitoring. Prostate cancer was found in 12 of the 90 patients (13.3 per cent), while 1 had metastatic leukemia to the prostate. Of the 90 patients 69 (76.7 per cent) had a palpably benign prostate and 2 malignancies (2.9 per cent) were diagnosed, while 11 malignancies occurred in 21 patients (52.4 per cent) with a suspicious examination. A total of 46 patients (51.1 per cent) underwent further prostate resection and no malignancy was found in any of these specimens: 43 underwent transurethral resection (24.9 gm. average), while 3 underwent open prostatectomy (97 gm. average). Other etiologies of acute retention included benign hyperplasia, other underlying illness, medical procedures, medications, prostatitis and prostatic infarction. Among the 44 patients who did not undergo prostatectomy 13 had treatment of the diagnosed cancer, 9 had resolution of retention and symptoms without intervention, 9 remained catheterized due to severe medical problems, 8 were treated for prostatitis, 2 had discontinuation of sympathomimetic drugs and 1 each underwent urethrotomy, bladder neck incision and resolution of prostatic infarction. In contrast to the older literature in which approximately 25 per cent of the patients presenting with acute urinary retention had prostate cancer, our data suggest a lower incidence. Prostatic biopsy for patients who present with acute urinary retention and a benign examination does not appear to be justified.
我们描述了对两个医疗中心收治的90例急性尿潴留患者的前瞻性评估。所有患者均有尿潴留前病史记录，并接受了仔细的前列腺检查、会阴前列腺活检以及后续治疗或监测。90例患者中有12例（13.3%）被发现患有前列腺癌，其中1例为前列腺转移性白血病。90例患者中，69例（76.7%）前列腺触诊为良性，诊断出2例恶性肿瘤（2.9%），而21例检查可疑的患者中有11例（52.4%）患有恶性肿瘤。共有46例患者（51.1%）接受了进一步的前列腺切除术，这些标本中均未发现恶性肿瘤：43例行经尿道前列腺切除术（平均24.9克），3例行开放性前列腺切除术（平均97克）。急性尿潴留的其他病因包括良性前列腺增生、其他基础疾病、医疗操作、药物、前列腺炎和前列腺梗死。在未接受前列腺切除术的44例患者中，13例接受了已确诊癌症的治疗，9例未经干预尿潴留和症状缓解，9例因严重医疗问题仍留置导尿管，8例接受了前列腺炎治疗，2例停用了拟交感神经药物，1例分别接受了尿道切开术、膀胱颈切开术和前列腺梗死的治疗。与既往文献中约25%的急性尿潴留患者患有前列腺癌相比，我们的数据表明发病率较低。对于急性尿潴留且检查为良性的患者，进行前列腺活检似乎没有必要。
