Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

Abstract

Key Summary points Aim To determine the prevalence of urinary retention and the role of screening for urinary retention on admission to an acute geriatric hospitalisation unit. Findings A post-void residual volume (PVR) >= 150 ml was present in 29.8% of patients and was independently associated with reporting voiding difficulties or referral to the hospital because of urinary symptoms. A PVR >= 300 was present in 16.0% of patients and was independently associated with not living at home, reporting subtotal voiding, having constipation, and referral to the hospital because of urinary symptoms. Message Screening for urinary retention is most indicated in patients with urinary and defaecation problems, but a low threshold for screening is recommended in all acutely ill geriatric patientsPurpose Urinary retention (UR) is common in older patients. The aim of this observational cohort study was to measure the prevalence of UR in patients aged >= 75 years on admission to an acute geriatric hospitalisation unit and to determine which at risk group would benefit from screening. Methods Post-void residual volumes (PVR) were measured within 3 days of admission with an ultrasound bladder scan. Uni- and multivariable analysis were used to determine risk factors associated with PVR >= 150 and >= 300 millilitres. Results Ninety-four patients, mean age 84.6 years, were included. The male/female ratio was 0.7. Patients with PVR >= 150 (29.8%) had more urological comorbidities, symptoms of overflow incontinence, voiding difficulties, subtotal voiding, faecal impaction, urinary tract infection (UTI) and were more frequently referred because of urinary symptoms. Patients with PVR >= 300 lived less at home, had more urological comorbidities, dysuria, voiding difficulties, subtotal voiding, constipation, faecal impaction, UTI, detrusor relaxants, and were more frequently referred because of urinary symptoms. Voiding difficulties and referral because of urinary symptoms were independently associated with PVR >= 150. Not living at home, reporting subtotal voiding, constipation, and referral because of urinary symptoms were independently associated with PVR >= 300. Conclusion Screening for UR on admission to an acute geriatric hospitalisation unit is most indicated in patients with urinary and defaecation problems. However, because the prevalence was high, because UR was also observed in patients without these problems, and history taking may be difficult, the threshold for PVR measurement in acutely ill geriatric patients should be low.