High pressure chronic retention: A life-threatening clinical entity

Abstract

Objectives: To report our experience with high pressure chronic retention (HPCR), a clinical syndrome with potentially disastrous consequences. Design: A prospective hospital based descriptive study. Setting: A urology unit at the National Hospital of Sri Lanka, Colombo. Patients: Forty seven consecutive new patients with HPCR evaluated during a 2-year period. Results: Of the 47 (39 male) patients, 15 (32%) were below 50 years of age. Nocturnal enuresis was encountered in 32 (68%) patients, and a tense, non-tender distended bladder found in all 47 patients. Hypertension was recorded in 25.5% of the patients. Bilateral hydroureteronephrosis was detected on ultrasonography in nearly 80% of the patients, and renal impairment was found in 20 (42.5%). The mean retained volume was 968 mL. Seven (15%) patients developed post-obstructive diuresis. Eight women (mean age 47.5 years, range 30-70 years) had HPCR. Four had no obvious cause. Six (75%) had adult onset nocturnal enuresis. Renal impairment was found in four (50%) patients. Post-obstructive diuresis was recorded in two women. Conclusions: HPCR, a clinical entity known to affect the elderly in the West, was found to affect a relatively young patient group in Sri Lanka. The symptom of adult-onset nocturnal enuresis should alert the clinician to the possibility of HPCR. Renal failure is common at initial presentation. Urethral catheterization could lead to life-endangering diuresis. We describe eight women with this entity, hitherto unreported in the medical literature.