Assessing referrals to urology outreach in cases of acute urinary retention

Abstract

INTRODUCTION: Acute Urinary Retention (AUR) is the sudden and often painful inability to pass urine characterised by a palpable or percussible bladder. It constitutes 45% of all lower urinary tract consultations and is encountered in different medical specialties. A local guideline was set up to delineate the management of acute urinary retention (AUR) in July 2018. It describes the clinical features, investigations and treatment required according to the severity of the episode. The aim of this audit is to assess the demographics of patients making use of the Urology Outreach Unit (cases of AUR), and trends in investigations done, treatment chosen and outcomes on such patients.

METHOD: All patients older than 16 years of age who presented with AUR between March 2018 and September 2018 were included. Data was obtained from Urology TWOC forms and corroborated with the hospital online system.

RESULTS: 89 (37.6%) of the referrals were done from Accident and Emergency Department (A&E), and 86 (36.3%) were referred from Urology firms. Urinalysis and Microscopy was sent in 45.1% of cases. Renal profile (serum) was taken in 70.5% of cases. The most commonly used catheter type used was silicone (89.6%). Catheter size of 16F was used in 83.8% of the cases. The average days spent with the catheter in situ was 11.7 days. The average attempts at TWOC was 1.1 times (max of 3). 83.5% of patients were then advised to continue their medical therapy with appropriate follow up following a successful TWOC. The rest were scheduled for a repeat TWOC (13.1%), fitted with a long-term catheter (1.69%), advised regarding self-intermittent catheterisation (1.27%), or referred for TURP (0.42%).

CONCLUSION: This audit shows variable compliance to clinical guidelines. An active role of the clinician in the management and treatment of AUR might improve treatment and reduce the risk of further episodes of AUR.