High pressure chronic retention: a life-threatening clinical entity

SAS Goonewardena, S Sivapriyan
2010 Ceylon Medical Journal  
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
more » ... se, 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 lifeendangering diuresis. We describe eight women with this entity, hitherto unreported in the medical literature.
doi:10.4038/cmj.v50i2.1572 fatcat:rwl7qb7hqrgrdhqk6jts32p7ba