Urethral catheterisation is often used in acute urinary retention (AUR). In this study, we aimed to evaluate the effect of urethral catheterisation on serum prostate-specific antigen (PSA) levels in men with AUR. Our study subjects comprised 35 men with a mean age of 63.7 +/- 7.35 years (range 55-80) who presented with AUR at our department between March 1999 and June 2000. Patients were randomly divided into two groups; 18 patient sunderwent urethral catheterisation in the first group (catheterisation group), while 17 underwent suprapubic percutaneous cystostomy in the second group (cystostomy group). Serum PSA levels before manipulation, and 2 and 12 hours and 7 days after treatment were determined. The change in median PSA values after manipulation was statistically significant in the catheterisation group (p< 0.05), but not in the cystostomy group (p> 0.05). The change in serum PSA was not clinically important in any of the patients. These results suggested that urethral catheterisation did not cause a significant alteration in serum PSA in men with AUR retention.
Acute Disease ; Aged ; Aged, 80 and over ; Human ; Male ; Middle Aged ; Prostate-Specific Antigen/*blood ; *Urinary Catheterization ; Urinary Retention/*blood/*therapy

BACKGROUNDMorphine has become the preferred drug for analgesia. However, analgesic doses of morphine can result in urinary retention, which is an intractable problem in clinical practice. Though bladder catheterization is one available therapeutic option, data supporting the technique's effectiveness are controversial. As a novel anti-cholinergic medicine developed in China, penehyclidine hydrochloride (PHC) exhibits greater selectivity for M(3)/M(1) receptors than M(2) receptors. Therefore, this study aimed to determine the efficacy of PHC in treating urinary retention.

METHODSThirty-two healthy male New Zealand white rabbits were randomly divided in four groups (n = 8 each) as follows: control group (C group), PHC low-dose group (PL group, 0.01 mg/kg of PHC intramuscularly), PHC middle-dose group (PM group, 0.02 mg/kg of PHC intramuscularly), and PHC high-dose group (PH group, 0.05 mg/kg of PHC intramuscularly). All rabbits were injected intravenously with morphine (1 mg/kg) to induce urinary retention and different doses of PHC were injected intramuscularly in the PL, PM and PH groups. In the C group, 1 ml saline was administered instead of PHC. The bladder pressure and the bladder sphincter pressure were recorded at different time points. The plasma concentration of PHC was measured at different time points with high performance liquid chromatography. Arterial blood pressure and heart rate (HR) were recorded at different time points.

RESULTSBladder pressure and urinary bladder sphincter pressure rose significantly from 30 minutes after morphine administration until the end of the experiment. PHC markedly attenuated the elevations in pressure induced by morphine. Morphometric analysis also revealed histological damage, erythrocytes and ruptures of the microcirculation in regions of the submucosa and smooth muscle. Morphometric damage was ameliorated with PHC but not with saline. Hemodynamic data (mean arterial pressure (MAP) and HR) did not differ between groups over the observation period.

CONCLUSIONSThis study demonstrated that intravenous morphine significantly increased bladder pressure and urinary bladder sphincter pressure and induced histological damage in the bladder and urinary bladder sphincter. Importantly, preliminary data showed that PHC could decrease the extent of these changes.

Analgesics, Opioid ; toxicity ; Animals ; Dose-Response Relationship, Drug ; Hemodynamics ; drug effects ; Male ; Morphine ; toxicity ; Pressure ; Quinuclidines ; blood ; therapeutic use ; Rabbits ; Urinary Bladder ; drug effects ; pathology ; Urinary Retention ; chemically induced ; drug therapy ; prevention & control

OBJECTIVETo sum up the clinical experience in the management of benign prostatic hyperplasia (BPH) with the prostate weighing over 80 ml by transurethral resection of the prostate (TURP) combined with 2 μm continuous-wave laser vaporesection (LVR).

METHODSWe retrospectively analyzed the clinical effects of TURP combined with 2 μm LVR in the treatment of 46 cases of BPH with the prostate volume > 80 ml.

RESULTSAll the operations were successfully accomplished. The operation time and intraoperative blood loss were (112.0 ± 20.0) min (range 86-176 min) and (77.9 ± 25.9) ml (range 50-200 ml), respectively. The catheters were withdrawn at 7 days after surgery. Transient urinary incontinence occurred in 6 cases and secondary hemorrhage was found in 2 postoperatively. Six-month follow-up revealed no urethral stricture or other complications. Compared with the baseline, the international prostate symptom score (IPSS) was significantly decreased at 6 months after operation (26.3 ± 1.8 vs 11.6 ± 1.7, P <0.05), and so were the quality of life (QOL) score (5.3 ± 0.7 vs 1.3 ± 1.1, P <0.05) and post-void residual urine (PVR) ([115.5 ± 55.6] ml vs [19.9 ± 11.6] ml, P <0.05). However, the maximum urinary flow rate (Qmax) was remarkably increased from (4.1 ± 2.6) ml/s to (16.2 ± 1.7) ml/s (P <0.05).

CONCLUSIONTURP combined with 2 μm LVR is safe and effective for the treatment of BPH with the prostate volume >80 ml.

Aged ; Blood Loss, Surgical ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Organ Size ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urethral Stricture ; Urinary Incontinence ; etiology ; Urinary Retention