AUR may foreshadow increased morbidity, mortality

London-Clinicians confronting acute urinary retention (AUR) would do well to not only resolve the retention, but to also look for and treat comorbid disease, which amplifies the risk of death in a disease state already associated with a high incidence of mortality, according to a study from urologists at University College London.

"For men with precipitated retention, the overall mortality was 25.3%, or about one in four," said James Armitage, MRCS, of the department of urology at University College London, who presented the research at the AUA annual meeting in Anaheim, CA.

He explained that spontaneous AUR was more or less of unknown etiology, whereas precipitated retention, a phrase believed to have been coined by Claus G. Roehrborn, MD, at the University of Texas Southwestern Medical Center in Dallas, is retention triggered by a specific event, such as surgery or medical intervention. In the absence of an identifiable triggering event, the retention is referred to as "spontaneous" and is presumed to be related to disease such as BPH progression.

"It is important to make this distinction," Dr. Armitage said. "There are higher mortality rates with precipitated retention. We suspect these rates are related to comorbid disease. We applied a comorbidity adjustment instrument to the data and found a strong correlation between the presence or absence of comorbid disease and the likelihood of death after retention.

"It may be more likely that the comorbidity is as responsible for the high mortality as is the retention per se."

Of those men with precipitated retention, approximately 56.5% had no identified comorbidity, leaving 43.5% with at least one comorbid condition, Dr. Armitage reported.

"This rate of comorbidity is about 50% higher than that seen among those with spontaneous retention," he said. "Overall, mortality increased from 16.1% among those with no comorbid disease to 38.1% in the group that harbored at least one comorbid condition."

The researchers found cardiovascular disease in about one-third of the patients with comorbid disease. One-fourth had diabetes and one-fourth had chronic pulmonary disease.

AUR was defined as primary in a specific patient if there was no previous record of AUR within 6 months. It was defined as spontaneous if the principal diagnosis was AUR or if BPH was the main diagnosis, with AUR recorded elsewhere in the records. During the roughly 7 years covered by the survey, 176,046 men were admitted with AUR.

Hastened death

Another important finding was that, regardless of the age group, nearly half of the deaths recorded appeared within 90 days of diagnosis. A very general observation would be that for each age group, the death rate doubled at 90 days and doubled again at 1 year.