MANAGEMENT OF URINARY RETENTION - RAPID VERSUS GRADUAL DECOMPRESSION AND RISK OF COMPLICATIONS

The literature was reviewed to quantify the risk of complications rela ted to the relief of obstruction in urinary retention. We also sought to determine whether the risk of complications is higher with rapid or gradual decompression (or ''clamping'') of the obstructed urinary bla dder. The medical literature was identified by a search of the MEDLINE database and a manual review of the bibliographies of the identified articles. Studies show that, after quick, complete relief of obstructi on, hematuria occurs in 2 to 16% of patients; however, clinically sign ificant hematuria is rare. After relief of obstruction, blood pressure often decreases, but it usually normalizes and does not progress to c linically significant hypotension. Post-obstructive diuresis occurs af ter relief of obstruction in 0.5 to 52% of patients; however, it is ea sily managed and rarely of clinical significance. We were unable to id entify any randomized controlled studies that directly compared quick, complete emptying with gradual emptying of the obstructed bladder. Mo reover, we identified no studies supporting the practice of gradual em ptying of the obstructed bladder. The available published studies supp ort quick, complete emptying for relief of the obstructed urinary blad der. We conclude that hematuria, hypotension, and post-obstructive diu resis may occur after decompression of the obstructed urinary bladder, but these complications are rarely clinically significant. Quick, com plete emptying of the obstructed bladder is safe, simple, and effectiv e and is recommended as the optimal method for decompressing the obstr ucted urinary bladder. Prudent, supportive care is needed for all pati ents, with special attention to elderly patients and those with hypovo lemia.