Urinary Retention – Benign Prostatic Hyperplasia (BPH)
When we hear 'urinary retention', our first thought may be of men with enlarged prostates – followed by thoughts regarding the treatment for this condition, Benign Prostate Hyperplasia (BPH).
According to an American Urological Association (AUA) Guideline, by the age of eighty, 80% of men in the United States will have prostatic enlargement.1
BPH is the growth of smooth muscle and epithelial cells in the center of the prostate and surrounding tissue – unrelated to cancer.
The enlargement of the prostate may apply pressure to the urethra causing some obstruction and possibly difficulty with urination. This urethral obstruction may result in low risk, lower urinary tract symptoms (LUTs) such as urgency, frequency, slow stream, and nocturia. When these symptoms are severe, they may be indicative of a higher risk issue such as urinary retention.
To help better investigate urinary retention, a provider should obtain a good health history including International Prostate Symptom Score (IPPS), Urine Analysis (UA), Post-Void Residual volume (PVR), and if possible, Uroflowmetry.
If this initial evaluation identifies a more high-risk situation such as hydronephrosis, elevated serum creatinine, infection, significant urinary incontinence then, treatment should be initiated.
First line therapy for BPH often includes medication such as Alpha Blockers, which 'relax' the smooth muscle in the transitional zone of the prostate, or 5-Alpha Reductase Inhibitors, which helps shrink the overall size of the prostate, or a combination of both. The goal of medication therapy is to improve bladder emptying.
If a trial of medication is not helpful, or if there is an escalation in risk – such as increased serum creatine or hydronephrosis worsens, it might be more appropriate to increase the level of care.
A foley catheter may need to be inserted or education on intermittent catheterization may need to be provided to help with bladder decompression either temporarily or long-term.
Remember that in intermittent catheter selection for the patient with an enlarged prostate, a larger French size catheter or a coudé tip catheter may be required to allow the catheter to pass by the prostatic obstruction more easily.
In many cases, one of several minimally invasive surgical treatments (MIST) or invasive procedures may be appropriate to improve bladder emptying.
Due to significantly elevated urine residuals, it is possible that post-surgically, further or new treatment for BPH symptoms is needed. For example, the patient may need to work on bladder retraining, take medicine, or perform intermittent catheterization long term.
References: 1. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE 2021
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