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urinary retention [keywords]
- Aortic Dissection. [JOURNAL ARTICLE]
- N Engl J Med 2014 Sep 18; 371(12):e17.
An 81-year-old man presented with suprapubic pain and urinary retention. Echocardiography showed aneurysmal dilatation and a dissection flap in the ascending aorta, shown in a short video. CT angiography revealed an ascending aortic aneurysm and a type I DeBakey aortic dissection.
- Urinary retention occurring one week after spinal anesthesia: a case of Elsberg syndrome. [JOURNAL ARTICLE]
- Can J Anaesth 2014 Sep 16.
We describe a case of urinary retention caused by viral sacral myeloradiculitis (Elsberg syndrome) that occurred one week after spinal anesthesia. The differential diagnosis of urinary retention after spinal anesthesia is discussed.A 76-yr-old male patient presented for operative removal of a right testicular hydrocele under spinal anesthesia. Anesthesia and surgery were uneventful, and he was discharged on the fifth postoperative day. Two days after discharge, he developed intermittent anal pain and voiding difficulty and was readmitted to hospital on the tenth postoperative day. He subsequently developed urinary retention, incontinence of feces, and difficulty in defecation. Magnetic resonance imaging showed no epidural hematoma, abscess, or other lesions in the spinal column, cauda equina, or spinal cord. Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord. A cerebrospinal analysis showed slight elevation of protein without pleocytosis. After neurologic consultation, herpetic sacral myeloradiculitis was suspected and intravenous acyclovir was administered along with large doses of methylprednisolone and immunoglobulin. The symptoms gradually resolved, and the difficulty in voiding resolved 19 days after initiation of the treatment. The patient was discharged 23 days after the start of the treatment without any other complications.This case suggests that Elsberg syndrome is important in the differential diagnosis of urinary retention after spinal anesthesia and should be discriminated from other anesthesia-related complications.
- Nontargeted SWATH acquisition for identifying 47 synthetic cannabinoid metabolites in human urine by liquid chromatography-high-resolution tandem mass spectrometry. [JOURNAL ARTICLE]
- Anal Bioanal Chem 2014 Sep 16.
Clandestine laboratories constantly produce new synthetic cannabinoids to circumvent legislative scheduling efforts, challenging and complicating toxicological analysis. Sundstrom et al. (Anal Bioanal Chem 405(26):8463-8474, ) and Kronstrand et al. (Anal Bioanal Chem 406(15):3599-3609, ) published nontargeted liquid chromatography, high-resolution, quadrupole/time-of-flight mass spectrometric (LC-QTOF) assays with validated detection of 18 and 38 urinary synthetic cannabinoid metabolites, respectively. We developed and validated a LC-QTOF urine method for simultaneously identifying the most current 47 synthetic cannabinoid metabolites from 21 synthetic cannabinoid families (5-fluoro AB-PINACA, 5-fluoro-AKB48, 5-fluoro PB-22, AB-PINACA, ADB-PINACA, AKB48, AM2201, JWH-018, JWH-019, JWH-073, JWH-081, JWH-122, JWH-200, JWH-210, JWH-250, JWH-398, MAM2201, PB-22, RCS-4, UR-144, and XLR11). β-Glucuronidase-hydrolyzed urine was extracted with 1-mL Biotage SLE+ columns. Specimens were reconstituted in 150-μL mobile phase consisting of 80 % A (0.1 % formic acid in water) and 20 % B (0.1 % formic acid in acetonitrile). Fifty microliters was injected, and SWATH™ MS data were acquired in positive electrospray mode. The LC-QTOF instrument consisted of a Shimadzu UFLCxr system and an ABSciex 5600+ TripleTOF® mass spectrometer. Gradient chromatographic separation was achieved with a Restek Ultra Biphenyl column with a 0.5-mL/min flow rate and an overall run time of 15 min. Identification criteria included molecular ion mass error, isotopic profiles, retention time, and library fit criteria. Limits of detection were 0.25-5 μg/L (N = 10 unique fortified urine samples), except for two PB-22 metabolites with limits of 10 and 20 μg/L. Extraction efficiencies and matrix effects (N = 10) were 55-104 and -65-107 %, respectively. We present a highly useful novel LC-QTOF method for simultaneously confirming 47 synthetic cannabinoid metabolites in human urine.
- Luxation antérieure d'un utérus rétroversé incarcéré à 21 semaines d'aménorrhée : à propos d'un cas. [JOURNAL ARTICLE]
- J Obstet Gynaecol Can 2014 Sep; 36(9):822-825.
Contexte : L'incarcération utérine se définit par un utérus gravide rétroversé dans le pelvis du fait de l'absence de bascule antérieure à la fin du premier trimestre. Les incarcérations utérines négligées ou découvertes perpartum peuvent entraîner des complications obstétricales graves. Plusieurs auteurs rapportent leur expérience de désincarcération utérine à 12, à 14 et à 16 semaines d'aménorrhée. Cas : Nous rapportons un cas de désincarcération utérine à 21 semaines d'aménorrhée obtenue par la combinaison d'un protocole d'anesthésie particulier et d'une installation de la patiente permettant un désenclavement de l'utérus aidé par des manœuvres externes. Aucun signe de récidive n'a été observé. Conclusion : La désincarcération utérine est possible au-delà de 16 semaines d'aménorrhée.
- Or14-2reducing harm of opioid dependence: ten-year experience of universal urinary hiv testing scheme in methadone treatment programme. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i51.
Opioid-dependent persons are vulnerable to HIV infection from unsafe injection and sexual practices. Early identification of HIV-infected cases and linkage to care remains a clinical and public health challenge. Since 2004, voluntary urinary HIV testing has been offered to all patients in Methadone Treatment Programme (MTP) in Hong Kong on admission and annually.Data from the Universal HIV Testing Scheme of MTP from 2004 to 2013 was analyzed. Outcomes including uptake and detection rates, follow-up and retention rates and HIV prevalence were evaluated.Over 90,000 urinary HIV tests were conducted, covering 71% to 91% of MTP patients annually. Among 75 HIV-infected MTP patients newly found by the testing scheme, 48 acquired HIV through drug injection and accounted for 19% of reported HIV cases who were transmitted by the same route between 2004 and 2013. Among the newly identified patients, 63% were successfully followed up by HIV clinic. The HIV prevalence among the MTP patients tested increased moderately from 0.20% (95% CI: 0.12-0.32) in 2004 to 0.68% (95% CI: 0.51 - 0.90) in 2013.A high coverage of HIV testing among opioid-dependent persons is achievable and provides significant contribution towards HIV surveillance, treatment and prevention of further spread in the population.
- Trigonal versus extratrigonal botulinum toxin-A: a systematic review and meta-analysis of efficacy and adverse events. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Sep 13.
Botulinum toxin-A (BoNT-A) is a potent neurotoxin that is an effective treatment for patients with pharmacologically refractory detrusor overactivity (DO). Data assessing the effectiveness of trigonal BoNT-A are limited. This study evaluates adverse events (AEs) and short-term efficacy associated with trigonal and extratrigonal BoNT-A.Electronic databases (PubMed, EMBASE, and the Cochrane database) were searched for studies comparing trigonal and extratrigonal BoNT-A for DO. Meta-analyses were performed using the random effects model. Outcome measures included incidence of AEs and short-term efficacy.Six studies describing 258 patients met the inclusion criteria. The meta-analysis did not show significant differences between trigonal and extratrigonal BoNT-A for acute urinary retention (AUR; 4.2 vs 3.7 %; odds ratio [OR]: 1.068, 95 % confidence interval [CI]: 0.239-4.773; P = 0.931) or high post-void residual (PVR; 25.8 vs 22.2 %; OR: 0.979; 95 % CI: 0.459-2.088; P = 0.956). The incidence of urinary tract infection (UTI; 7.5 vs 21.0 %; OR: 0.670; 95 % CI: 0.312-1.439; P = 0.305), haematuria (15.8 vs 25.9 %; OR: 0.547; 95 % CI: 0.264-1.134; P = 0.105) and post-operative muscle weakness (9.2 vs 11.3 %; OR: 0.587; 95 % CI: 0.205-1.680, P = 0.320) was similar in both groups. Finally, differences in short-term cure rates between two study arms were not statistically significant (52.9 vs 56.9 %; OR: 1.438; 95 % CI: 0.448-4.610; P = 0.542).Although data are limited, no significant differences between trigonal and extratrigonal BoNT-A in terms of AEs and short-term efficacy were observed. Additional randomised controlled trials are required to define optimal injection techniques and sites for administering intra-vesical BoNT-A.
- [Lazy bladder syndrome: Review of 126 cases]. [English Abstract, Journal Article]
- Prog Urol 2014 Sep; 24(10):651-7.
The lazy bladder syndrome (LBS) is characterized by an infrequent voiding, a large bladder capacity without neurological or urological disorders. In spite of being relatively common, there is little literature about it. The aim of our study was to compare the clinical features and urodynamic findings in asymptomatic or symptomatic patients with lazy bladder syndrome.We reviewed the charts of 126 adult patients diagnosed with lazy bladder syndrome. Clinical and radiological features, urodynamic findings and therapeutic management were evaluated. With these data, we divided patients into 2 groups: asymptomatic and symptomatic patients. After, we performed a comparative analysis of the data.The incident of LBS was significantly higher in women (81%). Twenty-one patients were asymptomatic (17%), 105 patients were symptomatic (83%). The patients with symptomatic LBS were significantly older (54.3 years±14.7). Voiding dysfunction (53%) and urinary retention (27%) were the most common symptoms in symptomatic group. In the uroflowmetry test, maximum and mean uroflow were significantly higher in asymptomatic group (P=0.0074). Reduced bladder sensation revealed no difference in the 2 groups, but in the symptomatic group, detrusor has also a poor contractility (P=0.0001). Nineteen patients (18%) had uro-nephrological complications.LBS is certainly underestimated. Voiding dysfunction, urinary retention in infrequent voiders or uro-nephrological complication (urinary tract infection with fever, ureteral reflux…) should recall LBS diagnosis. The hypothesis of bladder structural failure or autonomic nervous system dysfunction may be discussed (suggested).5.
- The value of surgical release after obstructive anti-incontinence surgery: An aid for clinical decision making. [JOURNAL ARTICLE]
- Neurourol Urodyn 2014 Sep 11.
To present satisfaction rates after surgical release of obstructive anti-incontinence surgery, to look for predictive factors for outcome and to define the optimal moment to perform the surgical release.We reviewed the charts of 87 women at first, second, and last follow-up at a median of 2 (0.5-7), 4 (2-12), and 108 (29-156) months after surgical release. Obstruction was defined as urinary retention, straining to void after overcorrected anti-incontinence treatment or urodynamic bladder outlet obstruction. Patients' satisfaction was assessed using a 4 point Likert scale.Satisfaction rates at first, second, and last follow-up were 66% (n = 54/82), 54% (n = 37/69), and 74% (n = 43/58) respectively. Postoperatively, patients complained about overactive bladder (OAB) symptoms in 37% (n = 30/81) and SUI in 28% (n = 23/81) at first follow-up and in 41% (n = 28/68) and 27% (n = 18/68) at second follow-up for OAB symptoms and stress urinary incontinence (SUI) respectively. When surgical release was performed more than 180 days after original surgery, less SUI (P = 0.008) was reported. When performed within 70 days in patients without pre-operative OAB symptoms, less post-operative OAB symptoms (P = 0.05) were reported.Surgical release can be very successful in relieving obstruction due to bladder outlet obstruction (BOO) after anti-incontinence surgery. Persistent OAB symptoms and recurrent SUI are the main reasons for being dissatisfied. To lower the odds for recurrent SUI, surgical release should be performed more than 180 days after original surgery. Patients without pre-operative OAB symptoms are at higher risk of developing post-operative OAB symptoms when treatment is delayed more than 70 days. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
- Short-acting spinal anesthesia in the ambulatory setting. [JOURNAL ARTICLE]
- Curr Opin Anaesthesiol 2014 Sep 10.
There has been a renewed interest in the short-acting local anesthetics articaine, chloroprocaine, and prilocaine for ambulatory spinal anesthesia because of numerous potentially beneficial factors both clinically and economically speaking. This review covers the current advances of the past 1 to 2 years.Literature search revealed a pleasing quantity of relevant articles. In various randomized, controlled trials (many different designs), chloroprocaine, articaine, and prilocaine performed mainly well as regards fast onset, satisfying block, and quick recovery. With these anesthetics transient neurologic symptoms were very rarely seen. Regarding urinary retention useful guidelines for bladder volume management were presented. In addition, various interesting features relating to unilateral spinal anesthesia and economical aspects were investigated.Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects.
- Prevention and management of postoperative urinary retention after urogynecologic surgery. [Journal Article, Review]
- Int J Womens Health 2014.:829-38.
Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%-43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function - the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4-6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk - either due to the procedures being performed or their clinical risk factors - should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair.