A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture

To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting.

We used the 2006-2010 Nationwide Emergency Department Sample (NEDS) to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management.

We identified 4,794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6.8±0.8 years. 4,084 (85%) received urethral dilation whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P<0.001), treated in recent years (p=0.002) and in the West (p=0.003). In multivariate analysis, SPT placement was significantly associated with younger age (p=0.004), public insurance (p=0.03), recent treatment years (p=0.02) and hospitals in West region (p=0.02). Income and hospital teaching status did not have significant association with initial treatment choice.

Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend towards SPT placement. Patients who are younger, publically insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.

Urology. 2016 Sep 19 [Epub ahead of print]

Michael A Granieri, Hsin-Hsiao S Wang, Jonathan C Routh, Andrew Peterson

Division of Urologic Surgery, Duke University Medical Center, Durham, NC. Electronic address: ., Division of Urologic Surgery, Duke University Medical Center, Durham, NC.

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