High pressure chronic retention: a life-threatening clinical entity
Goonewardena, S.A.S.; Sivapriyan, S.
Ceylon Medical Journal 50(2): 71-73
2005
ISSN/ISBN: 0009-0875 PMID: 16114772 Document Number: 592931
Objectives To report our experience with high pressure chronic retention (HPCR), a clinical syndrome with potentially disastrous consequences.Design A prospective hospital based descriptive study.Setting A urology unit at the National Hospital of Sri Lanka, Colombo.Patients Forty seven consecutive new patients with HPCR evaluated during a 2-year period.Results Of the 47 (39 male) patients, 15 (32%) were below 50 years of age. Nocturnal enuresis was encountered in 32 (68%) patients, and a tense, non-tender distended bladder found in all 47 patients. Hypertension was recorded in 25.5% of the patients. Bilateral hydroureteronephrosis was detected on ultrasonography in nearly 80% of the patients, and renal impairment was found in 20 (42.5%). The mean retained volume was 968 mL. Seven (15%) patients developed post-obstructive diuresis.Eight women (mean age 47.5 years, range 30-70 years) had HPCR. Four had no obvious cause. Six (75%) had adult onset nocturnal enuresis. Renal impairment was found in four (50%) patients. Post-obstructive diuresis was recorded in two women.Conclusions HPCR, a clinical entity known to affect the elderly in the West, was found to affect a relatively young patient group in Sri Lanka. The symptom of adult-onset nocturnal enuresis should alert the clinician to the possibility of HPCR. Renal failure is common at initial presentation. Urethral catheterization could lead to life-endangering diuresis. We describe eight women with this entity, hitherto unreported in the medical literature.