Kresevic Denise M, Dolinar Teresa, Early Allison, Burant Christopher J
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
University Hospitals Case Medical Center, Cleveland, Ohio.
Urol Pract. 2016 Mar;3(2):118-123. doi: 10.1016/j.urpr.2015.05.003. Epub 2015 Dec 22.
Current clinical practice guidelines aim to decrease the use of unnecessary indwelling urinary catheters to prevent catheter associated urinary tract infections. Patients with benign prostatic hyperplasia often experience increased post-void residual urine volume and subsequent bladder catheterization to prevent complications such as urinary tract infections or hydronephrosis. However, the management of urinary retention in patients with benign prostatic hyperplasia varies and clinical guidelines are lacking. In this study we gather information on post-void residual urine volume, the use of catheters and associated complications in a sample of older veterans with benign prostatic hyperplasia.
A retrospective chart review was performed using 660 patients screened for documented post-void residual urine volume greater than 100 cc, age greater than 65 years and the absence of cancer. A final chart review of 136 male veterans was performed for this analysis.
A total of 59 (43.4%) indwelling urinary catheters were placed. Catheters were placed in subjects with modest post-void residual urine volumes in the 100 to 150 cc range and in those with a post-void residual urine volume greater than 500 cc. Overall complication rates were low. Among those patients who had a catheter placed 51% reported hematuria, 36% reported pain and only 1 had documented urosepsis. Hydronephrosis occurred in 4 cases, each with a post-void residual urine volume of 301 to 400 cc, and 3 of these individuals had an indwelling urinary catheter placed. In those patients emergency room visits and hospitalizations were more frequently associated with placement of an indwelling urinary catheter.
Larger studies are needed for the development of clinical guidelines on the treatment of patients with benign prostatic hyperplasia and urinary retention.
当前的临床实践指南旨在减少不必要的留置导尿管的使用，以预防导尿管相关的尿路感染。良性前列腺增生患者常常出现排尿后残余尿量增加的情况，随后需要进行膀胱插管以预防诸如尿路感染或肾积水等并发症。然而，良性前列腺增生患者尿潴留的管理方法各不相同，且缺乏临床指南。在本研究中，我们收集了一组患有良性前列腺增生的老年退伍军人的排尿后残余尿量、导尿管使用情况及相关并发症的信息。
对660名经筛查记录排尿后残余尿量大于100cc、年龄大于65岁且无癌症的患者进行回顾性病历审查。最终对136名男性退伍军人的病历进行了此项分析。
共放置了59根（43.4%）留置导尿管。导尿管放置在排尿后残余尿量在100至150cc范围内的患者以及排尿后残余尿量大于500cc的患者中。总体并发症发生率较低。在那些放置了导尿管的患者中，51%报告有血尿，36%报告有疼痛，只有1例记录有尿脓毒症。4例发生肾积水，每例排尿后残余尿量为301至400cc，其中3人放置了留置导尿管。在这些患者中，急诊就诊和住院更常与留置导尿管的放置有关。
需要开展更大规模的研究来制定关于良性前列腺增生和尿潴留患者治疗的临床指南。
