Comment to: “Causes, characteristics and mid-term course of acute urinary retention in women referred to a Urodynamics Unit”

Prieto, L.

doi:10.1016/j.acuroe.2011.03.004

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Prieto" "autores" => array:1 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Prieto" "email" => array:1 [ 0 => "prieto_lui@gva.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Unidad de Urodinámica, Hospital Universitario de Elche, Alicante, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a: «Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica»" ] ] "textoCompleto" => "Surgery for stress urinary incontinence with the use of a mesh causes obstructive, irritative, or mixed voiding dysfunction in approximately 2–24% of cases.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The AUR, the significant postmictional residue, the voiding aid abdominal press, and the various abnormal postures to achieve bladder emptying suggest lower urinary tract obstruction. Detrusor pressure greater than 50cm H2O, along with a flow below 12ml/s or significant residue indicates obstruction.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> While this is true, there is a large percentage of cases that do not meet these criteria, and they improve after urethrolysis. The most relevant thing to establish the surgical indication is the appearance of de novo obstructive–irritative clinic, after surgery.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> This can lead to AUR and is usually accompanied by a greatly decreased urine flow, sometimes associated with the elevation of the postmictional residue. As urodynamic studies have no predictive preoperative value,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> they do help in some cases after surgery in these comorbidities, since some cases are clearly defined.Urethral stenosis in women may infrequently influence the ACU and accounts for 1% of the diagnoses of obstruction of the lower urinary tract in women if obstructive voiding dysfunctions are included. It can occur in, sometimes elderly, women; diabetic women with vulvovaginitis and recurrent infections, which affect the urethral meatus, unrelated to neurogenic detrusor hypocontractility, whose treatment would be the surgical treatment for stenosis. There are several vaginal flaps for urethral reconstruction with good results; these are the advancement flap, the rotation flap, and the proximal vaginal flap described by Palou.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> We must bear in mind that these flaps make the meatus take a hypospadic disposition, due to posterior retraction, which is worth noticing before surgery. Similar symptoms occur in trauma and pelvic fractures with urethral injury that involve organic stenosis. On examination, we can find, apart from the vesical globe, a great difficulty or impossibility for probing. Periodic urethral dilatations only get temporary relief, while obstructive symptoms return and voiding difficulty and pollakiuria persist. With reconstructive vaginal flap urethroplasty, voiding difficulty usually disappears; generally not existing obstructive clinic or restenosis.In the field of gynecology, acute postpartum urinary retention must be considered because of its frequency, being the common cause of consultation. Postpartum and puerperium untimely probing sometimes get involved in it, but certainly, there is a functional or neuropathic transient component. Its prevalence is variable according to its definition, and it is seen in 2.1% of births and 3.2% after a cesarean.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Other gynecological causes, such as endometrial cancer and cervical cancer are also described. In the field of urological causes, urachal cyst is also described as a cause of AUR in women.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The urachal cyst is present in approximately 2% of adults, and its diagnosis is difficult and secondary to the signs of its complications.Fowler's syndrome, which may also present as AUR in women, has a different consideration, and if the diagnostic study reveals no organic etiology, psychological research may be necessary because many patients have a significant psychosocial history. In the literature, there are psychological causes reported by some authors, but their scientific substrate in many cases is not worth mentioning.A final precision for the summary of this work, in the conclusions,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> highlights that what really matters is that after the episode of AUR, 106 women (52.4%) needed to continue with some treatment of greater importance to be cited than those that did not need it. The work that is presented, and that coincides with the practice that is performed in Functional Pathology Units, demonstrates the high percentage of patients requiring treatment and subsequent follow-up." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Prieto L. Comentario a: «Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica». Actas Urol Esp. 2011;35:394–95." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of video urodynamic results after the pubovaginal sling procedure using rectus fascia and polypropylene mesh for stress urinary incontinence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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Abrams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Urol" "fecha" => "1988" "volumen" => "61" "paginaInicial" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3342298" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstrucción tras cirugía correctora de la incontinencia femenina de esfuerzo. Diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Romero" 1 => "L. Prieto" 2 => "C. López" 3 => "J.M. Quilez" 4 => "E. 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Rodrigues Netto Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "207" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15881920" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estenosis uretral en la mujer: Etiología, diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Gutiérrez Ruiz" 1 => "F. Rodríguez-Escovar" 2 => "C. Errando Smet" 3 => "P. Arañó Bertrán" 4 => "H. 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Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0001-6349.2004.00460.x" "Revista" => array:6 [ "tituloSerie" => "Acta Obstet Gynecol Scand" "fecha" => "2004" "volumen" => "83" "paginaInicial" => "881" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15453880" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retención aguda de orina. “RAO”, como presentación de quiste de uraco" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Quicios Dorado" 1 => "E. Fernández Fernández" 2 => "I. Gómez García" 3 => "D. García Flórez" 4 => "C. De Castro Guerin" 5 => "A. Escudero Barrilero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "909" "paginaFinal" => "912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16353780" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. García-Fadrique" 1 => "G. Morales" 2 => "S. Arlandis" 3 => "M.A. Bonillo" 4 => "J.F. 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Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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