Commentary
Comment to: “Causes, characteristics and mid-term course of acute urinary retention in women referred to a Urodynamics Unit”
Comentario a: «Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica»
L. Prieto
Servicio de Urología, Unidad de Urodinámica, Hospital Universitario de Elche, Alicante, Spain
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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" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></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 50<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O, along with a flow below 12<span class="elsevierStyleHsp" style=""></span>ml/s or significant residue indicates obstruction.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></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"><span class="elsevierStyleSup">3</span></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"><span class="elsevierStyleSup">4</span></a> they do help in some cases after surgery in these comorbidities, since some cases are clearly defined.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">6</span></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"><span class="elsevierStyleSup">7</span></a> The urachal cyst is present in approximately 2% of adults, and its diagnosis is difficult and secondary to the signs of its complications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A final precision for the summary of this work, in the conclusions,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">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.</p>" ] ] "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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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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| 2015 October | 9 | 15 | 24 |
| 2015 September | 14 | 3 | 17 |
| 2015 August | 14 | 2 | 16 |
| 2015 July | 2 | 4 | 6 |
| 2015 June | 1 | 0 | 1 |
| 2015 May | 6 | 1 | 7 |
| 2015 April | 14 | 5 | 19 |
| 2015 March | 24 | 7 | 31 |
| 2015 February | 10 | 1 | 11 |
| 2015 January | 35 | 8 | 43 |
| 2014 December | 43 | 8 | 51 |
| 2014 November | 14 | 4 | 18 |
| 2014 October | 36 | 5 | 41 |
| 2014 September | 45 | 9 | 54 |
| 2014 August | 27 | 3 | 30 |
| 2014 July | 28 | 1 | 29 |
| 2014 June | 19 | 5 | 24 |
| 2014 May | 19 | 1 | 20 |
| 2014 April | 12 | 4 | 16 |
| 2014 March | 19 | 1 | 20 |
| 2014 February | 19 | 4 | 23 |
| 2014 January | 11 | 3 | 14 |
| 2013 December | 14 | 1 | 15 |
| 2013 November | 14 | 5 | 19 |
| 2013 October | 12 | 4 | 16 |
| 2013 September | 13 | 1 | 14 |
| 2013 August | 14 | 2 | 16 |
| 2013 July | 3 | 0 | 3 |
Show all
