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Causes, characteristics and mid-term course of acute urinary retention in women referred to a urodynamics unit
Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica
G. García-Fadrique
, G. Morales, S. Arlandis, M.A. Bonillo, J.F. Jiménez-Cruz
Corresponding author
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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"apellidos" => "Jiménez-Cruz" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute urinary retention (AUR) is the sudden inability to empty the bladder content. It is an uncommon entity in women, whose incidence is estimated at 0.07 per 1000 inhabitants each year.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It may relate to different disorders. Unlike what happens in men, the AUR in women is not usually due to obstructive processes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In men, benign prostatic hypertrophy plays an essential role. In women, it often appears in the context of a gynecological or neurological disease. Pharmacological or surgical iatrogenesis is also common. In a considerable percentage of cases the cause cannot be identified, and given that additional examinations are normal, a psychogenic component is suspected.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Not all the women who suffer an episode of AUR are referred to urology, as in most cases it is a specific episode without repercussions. However, in some women, neurological or urogynecological disorders that require further study, close monitoring, or the establishment of a treatment are detected. The aim of this work focuses on describing the causes of AUR in women referred to a specific unit of functional disorders and analyzing the medium-term evolution of these.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a retrospective descriptive study including all the women who were referred to our Neurourology and Urodynamics Unit after suffering an AUR between January 1989 and December 2006.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We reviewed the medical records of the patients, including personal history, concomitant medication, general physical examination, neurological and urogynecological examination and medium-term development. We performed a urine culture and a complete urodynamic study during the AUR episode once it was overcome. The study included, in all the cases, free flowmetry, filling cystometry and pressure-flow study. Sometimes other additional tests such as electromyography, evoked potentials or magnetic resonance imaging were necessary.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">The studied patients were 202, with a median age of 57 years (range 12–87 years). Prior to the episode of AUR, 58 patients (28.7%) had voiding symptoms, consisting of difficulty in starting urination, weak and intermittent stream, voiding difficulty or feeling of incomplete emptying.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the digestive history in 44 patients (21.8%), there was history of chronic constipation, 82 patients (40.6%) had normal intestinal rhythm and two (1%) irritable bowel syndrome. In 74 patients (36.6%) information on this aspect was not available. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the urodynamic patterns. The most common finding was bladder hypocontractility (65 patients, 32.2%), followed by normal study (64 patients, 31.7%), and acontractility (37 patients, 18.3%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The causes of the AUR were divided into 9 categories, whose respective percentages are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The most frequent cause was unknown (46 cases, 23%). This group includes women with no comorbidity and no apparent cause of voiding dysfunction, but with pathological urodynamic study.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The following etiological group, in order of frequency, is made of neurological causes (53 patients, 26%). Among these, 11 infections in the nervous system, 9 spinal tumors, 5 multiple sclerosis, 16 vasculo-medullary injuries, two strokes, two slipped disks, 4 iatrogenic neuropathies after spinal manipulation or spinal anesthesia, an Alzheimer's disease, two rachischisis, and one hydrocephalus were detected. Diabetes mellitus is the next causal group (22 cases, 11%), followed in turn by psychogenic cause (21 cases, 10%) in women without comorbidity and with normal urodynamic study.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The gynecological cause (19 cases, 9%) was very varied: 8 neurological injuries after abnormal labor, hysterectomy or pelvic radiotherapy; 11 infravesical obstructions (4 cystocele, an ovarian tumor, a uterine fibroid, two lower lip synechiae, a hematocolpos, a descended pregnant uterus, and two patients with a history of colporrhaphy). The urological causes (16 cases, 8%) revealed: three urethral stenoses, three retentions after the placement of a suburethral mesh, 6 urinary tract infections, a urethral diverticulum, an acute nephritic renal colic, a urethral caruncle, and a history of cystoplasty.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Other less frequent causes were: immediate postoperative period after hip prosthesis placement (12 cases, 6%), pharmacological cause (tricyclic antidepressants, opioids, and antimuscarinics) (10 cases, 5%) and digestive cause (three cases, 2%) (one fecaloma and two retentions after abdominoperineal rectal amputation). From the point of view of the after-effects, only 14 women (6.9%) developed acute renal failure with creatinine levels above 1.4<span class="elsevierStyleHsp" style=""></span>mg/dl. All of them achieved normal renal function once the treatment was established.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After the episode of AUR, with a median follow-up of 28 months (range 3–217 months), 96 patients (47.6%) remained asymptomatic and therefore did not require any treatment. However, 106 women (52.4%) continued having some type of voiding dysfunction, and needed treatment: most of these patients received an alpha-blocker (47 women, 44.3%); 45 women (42.4%) started a regime of self-catheterization; 10 patients (9.4%) required an indwelling catheter, and 4 women (3.9%) surgery consisting of internal urethrotomy, transurethral resection of cervix or periodic dilations.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">One of the discrepancies between the AUR observed in women and that presented by men is that in men it is usually preceded by a symptomatology of months or years of evolution. Benign prostatic hypertrophy is by far the leading cause of AUR in men, and it usually reflects the abandonment of a bladder that has been struggling to overcome the flow obstruction for a long time.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In contrast, the AUR in women is not usually associated with infravesical obstruction<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and is not preceded by any symptomatology. Nevertheless, we must not forget that in many cases, especially in the elderly, women develop symptoms of chronic urine retention with a minimum of symptomatology presented.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A detailed history is crucial in determining the etiology of the AUR. In the same way that the patients are asked about the urinary symptomatology of filling and emptying, they should be asked about their digestive habits, because many times they report an altered intestinal rhythm.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Being a retrospective study based on the review of medical records, we could not get information about this aspect in all the cases. However, in our series, there is a significant number of patients who met chronic constipation criteria or who suffered from irritable bowel syndrome.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nowadays, ultrasound remains of great value in the study of voiding disorders. The test is inexpensive, simple, and available in almost all centers; and it provides information on the bladder, the bladder cervix and pelvic organs. The urodynamic study is essential to perform a correct diagnosis of these patients and to choose the most beneficial treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The urodynamic pattern most frequently found in both our series and in previous publications is the bladder hypocontractility. This is defined by the existence of contractions of reduced strength and/or duration, which entails a sustained voiding and/or failure to achieve complete emptying in a normal time.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> In some series, in fact, up to 50% of urodynamic studies showed bladder hypocontractility.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This coincides with the fact that behind the majority of the women who suffer an AUR there exists a neurological disorder. The infravesical obstruction, however, is rare.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,11</span></a> With a 10.4%, our values are close to those previously published by Klarskov et al. (11.1%).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This type of patients constitutes the group with better prognosis, since most cases are solved successfully by surgery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">With regard to the causes, the neurological one is the most common in most series.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This leaves behind the classical belief that most of the retentions in women are of a psychogenic nature,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,12</span></a> this etiology being relegated to children<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and patients with psychiatric comorbidity, mainly depression and anxiety syndrome.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Fowler et al. observed that 72% of the patients with AUR showed an alteration in the behavior of the external sphincter detected by electromyography during the voiding phase.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> So, it was shown that some cases previously labeled as psychogenic had an objectifiable functional component.</p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to infravesical obstruction as a cause of AUR, it is important to highlight the involvement of the pelvic organs<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and complication after surgery for incontinence.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The AUR after surgery for incontinence usually occurs within 24<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> If, however, it takes place later, the prognosis is usually worse and it usually requires urethrolysis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The anti-incontinence techniques through transobturator are faster and with fewer complications in terms of voiding dysfunction. This problem occurs in 3–32% after colposuspension<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and only in 3–15% after TVT.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Some rare causes of infravesical obstruction have been described, such as imperforate hymen,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> paraurethral leiomyoma or retroverted gravid uterus.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The genital herpes virus can affect pelvic nerves causing not only AUR but also neurogenic pain in the sacral area.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There is often a history of gynecological surgery in patients suffering from AUR. Uccella et al. compared open and laparoscopic hysterectomy in patients with cervical cancer and observed a similar complication rate, with AUR in 14% of the laparoscopic and in 14.6% of the open (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.11) hysterectomies.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Gimbel et al. compared the total and subtotal hysterectomy in relation to lower urinary tract symptoms, finding less incontinence and urgency in the total ones, but no difference in emptying or the development of AUR.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The physiopathological mechanism by which AUR occurs after pelvic surgery is not exactly known. Some of the hypotheses are pelvic nerve or bladder damage, edema around the bladder neck or sphincter contraction, reflecting perineal pain.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> AUR is the most common complication after benign anorectal surgery.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">This work has a considerable selection slant, since only women who have been valued at a specific unit have been included. This explains why spinal vascular lesions, despite their low incidence in the general population, are presented as the main cause of AUR.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding the impact on the upper urinary tract, the determining factor is the time the patient takes to see a doctor. Few women delay the consultation as if to develop acute renal failure. In general, once the urine is derived, the renal function is recovered. In our series, 52.4% of the patients required medium-term treatment (alpha blockers, permanent catheterization, intermittent catheterization or surgery) due to the persistence of some degree of voiding dysfunction. In the same way that intermittent catheterization was used mainly in the AUR associated with neurological processes, surgery was helpful in women with urethral lesions or with a history of urogynecological surgery. The most accepted treatment in AURs developed in the immediate postoperative period is intermittent catheterization.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Neuromodulation meant an improvement in many patients, in some cases replacing the intermittent self-catheterization.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Other therapies, such as sphincter injection of botulinum toxin, are still under study.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Benign prostate growth and voiding disorders in men have been widely studied, but more research about the mechanism by which AUR develops in women is needed. In our series, focusing on the work of a Urodynamics Unit of a tertiary hospital, the AUR in women is usually caused by an underlying neurological or urogynecological disease, although in a significant percentage of patients the cause was not identified. Half of the patients recovered completely and did not require any treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres98396" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec85556" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres98395" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec85555" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-10" "fechaAceptado" => "2011-03-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec85556" "palabras" => array:4 [ 0 => "Female gender" 1 => "Urinary retention" 2 => "Acute disease" 3 => "Urodynamics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec85555" "palabras" => array:4 [ 0 => "Sexo femenino" 1 => "Retención urinaria" 2 => "Enfermedad aguda" 3 => "Urodinámica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the characteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a descriptive retrospective study (January 1982–December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 202 women were included, median age of 57 years (12–87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La retención aguda de orina (RAO) es poco frecuente en mujeres y puede relacionarse con distintas patologías. Sólo algunas pacientes son remitidas a una Unidad de Urodinámica para un estudio más exhaustivo. Se pretende describir las características y causas de RAO en las mujeres derivadas a nuestra unidad y analizar su evolución a medio plazo.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo (enero 1982- diciembre 2006) incluyendo las mujeres derivadas a la Unidad de Urodinámica tras sufrir una RAO. Se revisaron las historias clínicas con especial énfasis en antecedentes personales, exploración física, así como estudio urodinámico completo durante el episodio de RAO y una vez superado este.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 202 mujeres, con una mediana de edad de 57 años (12- 87). Previamente 59 pacientes (28,7%) presentaban síntomas de vaciado. Los patrones urodinámicos que se encontraron fueron: 65 hipocontractilidad vesical (32,2%), 64 estudio normal (31,7%), 37 acontractilidad (18,3%), 21 obstrucción infravesical (10,4%) y 15 ausencia de relajación de suelo pélvico (7,4%). Las principales causas de RAO fueron: 53 neurológica (26,2%); 46 causa desconocida (22,8%); 19 ginecológica (9,4%); 22 diabetes mellitus (10,9%); y 16 urológica (7,9%). Deterioraron la función renal 14 mujeres (6,9%). Tras la RAO 106 mujeres (52,4%) necesitaron continuar con algún tipo de tratamiento.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie la RAO en mujeres suele ser consecuencia de una enfermedad neurológica o uroginecológica subyacente, aunque en un porcentaje importante de pacientes no se logra filiar la causa. La mitad de las pacientes se recuperaron totalmente y no precisaron ningún tipo de tratamiento.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: García-Fadrique, et al. 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;35:389–93.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Urodynamic pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bladder hypocontractility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (32.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (31.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bladder acontractility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (18.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravesical obstruction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (10.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absence of relaxation of the pelvic floor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (7.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183683.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of patterns reflected in the urodynamic study.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Etiologic groups \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (26%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (11%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gynecological causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urological causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immediate postoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pharmacological causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Digestive causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Psychogenic cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (10%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (23%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183682.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Percentage of identified causal groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute urinary retention in women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.F. Van der Linden" 1 => "P.L. Venema" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ned Tijdschr Geneeskd" "fecha" => "1998" "volumen" => "142" "paginaInicial" => "1603" "paginaFinal" => "1606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9763841" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructed voiding in the female" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Massey" 1 => "P.H. Abrams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Urol" "fecha" => "1988" "volumen" => "61" "paginaInicial" => "36" "paginaFinal" => "39" "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" => "Psychogenic urinary retention in women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.M. Barrett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "1976" "volumen" => "51" "paginaInicial" => "351" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1271850" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urinary retention in adults: diagnosis and initial management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.A. Selius" 1 => "R. Subedi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2008" "volumen" => "77" "paginaInicial" => "643" "paginaFinal" => "650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18350762" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic chronic urinary retention in the female" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Fox" 1 => "G.J. Jarvis" 2 => "L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2018 February | 77 | 1 | 78 |
| 2018 January | 41 | 1 | 42 |
| 2017 December | 73 | 0 | 73 |
| 2017 November | 45 | 4 | 49 |
| 2017 October | 13 | 1 | 14 |
| 2017 September | 17 | 8 | 25 |
| 2017 August | 19 | 2 | 21 |
| 2017 July | 26 | 1 | 27 |
| 2017 June | 22 | 12 | 34 |
| 2017 May | 19 | 6 | 25 |
| 2017 April | 14 | 3 | 17 |
| 2017 March | 15 | 5 | 20 |
| 2017 February | 15 | 3 | 18 |
| 2017 January | 4 | 2 | 6 |
| 2016 December | 8 | 4 | 12 |
| 2016 November | 18 | 6 | 24 |
| 2016 October | 26 | 7 | 33 |
| 2016 September | 16 | 8 | 24 |
| 2016 August | 12 | 1 | 13 |
| 2016 July | 14 | 1 | 15 |
| 2016 June | 18 | 6 | 24 |
| 2016 May | 30 | 9 | 39 |
| 2016 April | 18 | 13 | 31 |
| 2016 March | 21 | 12 | 33 |
| 2016 February | 31 | 16 | 47 |
| 2016 January | 22 | 15 | 37 |
| 2015 December | 19 | 14 | 33 |
| 2015 November | 15 | 8 | 23 |
| 2015 October | 17 | 15 | 32 |
| 2015 September | 15 | 8 | 23 |
| 2015 August | 11 | 10 | 21 |
| 2015 July | 15 | 7 | 22 |
| 2015 June | 3 | 5 | 8 |
| 2015 May | 15 | 7 | 22 |
| 2015 April | 23 | 14 | 37 |
| 2015 March | 27 | 14 | 41 |
| 2015 February | 8 | 5 | 13 |
| 2015 January | 30 | 8 | 38 |
| 2014 December | 39 | 14 | 53 |
| 2014 November | 28 | 5 | 33 |
| 2014 October | 40 | 10 | 50 |
| 2014 September | 34 | 11 | 45 |
| 2014 August | 37 | 6 | 43 |
| 2014 July | 24 | 6 | 30 |
| 2014 June | 21 | 8 | 29 |
| 2014 May | 20 | 4 | 24 |
| 2014 April | 17 | 6 | 23 |
| 2014 March | 14 | 1 | 15 |
| 2014 February | 18 | 5 | 23 |
| 2014 January | 6 | 3 | 9 |
| 2013 December | 15 | 4 | 19 |
| 2013 November | 20 | 2 | 22 |
| 2013 October | 25 | 6 | 31 |
| 2013 September | 12 | 2 | 14 |
| 2013 August | 15 | 2 | 17 |
| 2013 July | 4 | 1 | 5 |
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