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Chronic Urinary Retention
Comparative Effectiveness Reviews, No. 140
Investigators: Michelle Brasure, PhD, MSPH, MLIS, Howard A Fink, MD, MPH, Michael Risk, MD, Roderick MacDonald, MS, Tatyana Shamliyan, MD, Jeannine Ouellette, Dongjuan Xu, MSc, Mary Butler, PhD, Robert L Kane, MD, and Timothy J Wilt, MD, MPH.
Author Information and AffiliationsStructured Abstract
Objective:
To determine the effectiveness and comparative effectiveness of treatments for chronic urinary retention (CUR), also termed partial or persistent urinary retention or incomplete bladder emptying, in adults.
Data sources:
Ovid MEDLINE® and the Cochrane Central Register of Controlled Trials bibliographic databases; hand searches of references of relevant studies.
Review methods:
Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials and prospective cohort studies enrolling patients with CUR. Primary outcomes included rate of urinary tract infections, urinary symptom or quality-of-life score category, and successful trial without catheter. Intermediate outcomes included postvoid residual (PVR) urine volume and continuous measures of urinary symptoms or quality of life. We extracted data, assessed risk of bias on individual studies, and evaluated strength of evidence for each comparison and outcome.
Results:
We identified 11 publications reporting original research and 2 relevant systematic reviews that met eligibility criteria. Results are analyzed by etiology: obstructive, nonobstructive, and mixed populations/unknown causes. Only three studies addressed obstructive causes of CUR; all studied men with bladder outlet obstruction due to benign prostatic enlargement. Low-strength evidence suggested that transurethral resection of the prostate and microwave therapy achieved similar improvements in the rates of successful trial without catheter at 6 months posttreatment. Evidence was insufficient to draw conclusions regarding other outcomes because estimates were imprecise, risk of bias was moderate, and consistency could not be evaluated. Evidence for other treatment comparisons for CUR from obstructive causes was insufficient to conclude that one treatment was more effective than the comparison. Four small studies and one systematic review assessed treatments for CUR from nonobstructive causes. A previous systematic review provided low-strength evidence that neuromodulation improves the rate at which patients with Fowler's syndrome can be catheter free after treatment. Low-strength evidence suggested that botulinum toxin injected into the urethral sphincter may not improve PVR volumes. Two studies and one systematic review addressed CUR treatments in mixed populations or CUR from unknown causes. Evidence from original research was insufficient to conclude that one treatment was any more or less effective than another. Evidence on harms was inconsistently reported across all interventions, and no differences were detected across treatment groups; however, studies were not adequately powered to detect differences in harms across groups.
Conclusions:
We identified few studies; most were small and had methodological flaws. Evidence was insufficient due to risk of bias and imprecision, and we were not able to evaluate consistency of results across studies. Further research should address conceptual issues in studying CUR as well as strengthening the evidence base with adequately powered controlled trials or prospective cohort studies for populations and interventions common in practice.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- References
- Abbreviations
- Appendix A CUR Treatments
- Appendix B Analytical Framework
- Appendix C Search Strategy
- Appendix D Inclusion Criteria
- Appendix E Excluded Studies
- Appendix F Description and Characteristics of Included Studies
- Appendix G Risk of Bias and Quality
- Appendix H Detailed Results
- Appendix I Strength of Evidence
- Appendix J Ongoing Studies
- Appendix K Future Research Needs
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10064-I. Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, MN
Suggested citation:
Brasure M, Fink HA, Risk M, MacDonald R, Shamliyan T, Ouellette J, Xu D, Butler M, Kane RL, Wilt TJ. Chronic Urinary Retention: Comparative Effectiveness and Harms of Treatments. Comparative Effectiveness Review No. 140. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I.) AHRQ Publication No. 14-EHC041-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10064-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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