User:Sunavsky/sandbox

Edit Suggestions
Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. In the Epidemiology section, we suggest adding: "Urinary retention in females is uncommon, occurring 1 in 100,000 every year, with a female-to-male incidence rate of 1:13. It is usually transient and quite clinically ill-defined in some cases. The causes of UR in women can be multi-factorial, and can be postoperative and postpartum. Prompt urethral catherization usually resolves acute emergency UR. "

2. Add a section called “postoperative urinary retention risk factors” and add the following information:

Postoperative urinary retention risk factors: age, medications, anesthetics, benign prostatic hyperplasia/lower urinary tract symptoms, and surgery related factors, including operating room time, intravenous fluids, and procedure type.

"Age:""Older patients can suffer from degeneration of neural pathways involved with bladder function and it can be responsible for the increased risk of postoperative urinary retention. The risk of postoperative urinary retention increases up to 2.11 fold for patients older than 60 years.""Sex:""Another risk factor is sex. It has been shown that sex increases risks for urinary retention not related to surgery given. For men, benign prostatic hyperplasia increases risk, due to the fact that it’s a risk factor for lower urinary tract dysfunction and retention. This association has not been as strongly elucidated for postoperative urinary retention.""Medications:""The following medications are associated with increased risks of postoperative urinary retention: anticholinergics and medications with anticholinergic properties, alpha-adrenergic agonists, opiates (The incidence of opioid precipitated retention in the postoperative setting has been found to be as high as 25%. ), nonsteroidal antiinflammatories (NSAIDs) (up to 2 fold. ), calcium-channel blockers and beta-adrenergic agonists.""Anesthesia:""General anesthetics can cause bladder atony by acting as smooth muscle relaxants. In addition to that, it can directly interfere with autonomic regulation of detrusor tone and predispose patients to bladder overdistention and subsequent retention. On the other hand, spinal anesthesia results in a blockade of the micturition reflex.  Overall, spinal anesthesia shows a higher risk of postoperative urinary retention compared to general anesthesia.""Benign prostatic hyperplasia:""Men with benign prostatic hyperplasia are at an increased risk of acute urinary retention. This finding is supported by a meta-analysis of 570 articles. It was established that lower urinary tract symptoms were significantly associated with an increased risk of urinary retention (OR 2.83).""Surgery related:""Operative times longer than 2 hours increased the risk of postoperative urinary retention 3-fold. 17 Longer surgery times increase patients’ risks of urinary retention. A rule of thumb suggests that for operative cases lasting longer than 3 hours, a Foley catheter should be inserted preoperatively. Overall, there is a theory that longer operative times, increased amounts of IV fluids, and higher doses of anesthetics and opiates likely all together increase risks of postoperative urinary retention."""

3. We suggest describing the pathophysiology of chronic urinary retention in a concise manner.

Chronic urinary retention that is due to bladder blockage which can either be as a result of muscle damage or neurological damage. If the retention is due to neurological damage, there is a disconnect between the brain to muscle communication, thereby inhibiting complete voiding of the bladder. If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.

"The most common cause of chronic urinary retention is BPH. BPH is a result of the ongoing process of testosterone being converted to dihydrotestosterone which stimulates prostate growth. Over the lifetime of an individual, the prostate experiences continual growth due to the testosterone to dihydrotestosterone conversion which can cause the prostate to obstruct the urethra, causing urinary retention.

4. In the treatments section, we suggest that we replace the New York Times citation with an peer-reviewed paper.

Additionally, we suggest adding the following information in regards to self-catheterization such as: "Urinary retention combined with recurrent or chronic urinary tract infection may require continued intermittent self-catheterization as this has been shown to reduce infection. While clean Intermittent self catheterization (CISC) is currently the gold standard for patients with urinary retention--and has a lower infection risk compared to catheterization that stays within the body; however, there can be challenges with compliance for intermediate catheterization. For example, with older demographics, who are incapable or lack the dexterity for self catheterization.

5. Add the following to the diagnosis section:

"Non-neurogenic Chronic Urinary Retention does not have a standardized definition, but urine volumes >300mL can be used as an informal indicator of chronic urinary retention. The retention has to be present for a period of time greater than 6 months, that is to say, 2 separate measurements of urine volume 6 months apart should have a PVR volume >300mL. CUR can be caused by bladder outlet obstruction and/or an underactive bladder (detrusor underactivity).

6. In the first paragraph of the treatment section of the article, there is a sentence that states, “5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal”. However, the citation for this statement actually indicates that alpha blockers, not alpha-reductase inhibitors, increase the chance of normal urination following catheter removal. As such, we would suggest amending the statement to say, “Use of alpha-blockers can provide relief of urinary retention following de-catheterization for both men and women. ”

In addition, under the “Medication” section of the page, it states, “Some people with BPH are treated with medications. These include tamsulosin to relax smooth muscles in the bladder neck, and finasteride and dutasteride to decrease prostate enlargement. ”

Thank you very much for taking time to provide us with feedback. Sunavsky (talk) 17:04, 10 November 2017 (UTC)