Mark Emberton and urinary retention : database analysis Mortality in men admitted to hospital with acute

Objectives To investigate mortality in men admitted to hospital with acute urinary retention and to report on the effects of comorbidity on mortality. Design Analysis of the hospital episode statistics database linked to themortality database of the Office for National Statistics. Setting NHS hospital trusts in England, 1998-2005. Participants All men aged over 45 who were admitted to NHS hospitals in England with a first episode of acute urinary retention. Main outcome measuresMortality in the first year after acute urinary retention and standardised mortality ratio against the general population. Results During the study period, 176046 men aged over 45 were admitted to hospital with a first episode of acute urinary retention. In 100067 men with spontaneous acute urinary retention, the one year mortality was 4.1% in men aged 45-54 and 32.8% in those aged 85 and over. In 75979 men with precipitated acute urinary retention, mortality was 9.5% and 45.4%, respectively. In men with spontaneous acute urinary retention aged 75-84, the most prevalent age group, the one year mortality was 12.5% inmenwithout comorbidity and28.8% inmenwith comorbidity. The corresponding figures for men with precipitated acute urinary retention were 18.1% and 40.5%. Compared with the general population, the highest relative increase in mortality was in men aged 45-54 (standardised mortality ratio 10.0 for spontaneous and 23.6 for precipitated acute urinary retention) and the lowest for men 85 and over (1.7 and 2.4, respectively). ConclusionsMortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity. Patients might benefit from multi-disciplinary care to identify and treat comorbid conditions. INTRODUCTION Acute urinary retention is a severe complication of benign prostatic hyperplasia. With an ageing population, it represents a major public health issue in the westernworld.The reported incidenceof acute urinary retention in large population based studies varies from 2.2 to 6.8 per 1000 men per year. As many as one in 10 men in their 70s may experience acute urinary retention within five years. It is a urological emergency that requires immediate treatmentwith a urinary catheter. After the acute period, most men will be offered a trial without catheter and about 60% will resume spontaneous voiding. In theUnitedKingdom, about one in five will undergo further surgical treatment in the next six months, but about 15% will experience a recurrence within the same time period. Although acute urinary retention is a direct manifestation of progression of benign prostatic hyperplasia, several studies have also found associations with major morbidities. 6-8 Occurring either spontaneously or after a precipitating event, it may therefore be a “harbinger” of severe systemic disease. We studied to what extent the occurrence of acute urinary retention among men admitted to hospital confers an increased risk of death compared with men in the general population of similar age.