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Topic Title

  • Chronic Urinary Retention: Comparative Effectiveness and Harms of Treatments

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Original Nomination



Research Review - Final – Sept. 15, 2014

Chronic Urinary Retention: Comparative Effectiveness and Harms of Treatments

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Structured Abstract

Objective

To determine the effectiveness and comparative effectiveness of treatments for chronic urinary retention (CUR), also termed partial or persistent urinary retention or incomplete bladder emptying, in adults.

Data sources

Ovid MEDLINE® and the Cochrane Central Register of Controlled Trials bibliographic databases; hand searches of references of relevant studies.

Review methods

Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials and prospective cohort studies enrolling patients with CUR. Primary outcomes included rate of urinary tract infections, urinary symptom or quality-of-life score category, and successful trial without catheter. Intermediate outcomes included postvoid residual (PVR) urine volume and continuous measures of urinary symptoms or quality of life. We extracted data, assessed risk of bias on individual studies, and evaluated strength of evidence for each comparison and outcome.

Results

We identified 11 publications reporting original research and 2 relevant systematic reviews that met eligibility criteria. Results are analyzed by etiology: obstructive, nonobstructive, and mixed populations/unknown causes. Only three studies addressed obstructive causes of CUR; all studied men with bladder outlet obstruction due to benign prostatic enlargement. Low-strength evidence suggested that transurethral resection of the prostate and microwave therapy achieved similar improvements in the rates of successful trial without catheter at 6 months posttreatment. Evidence was insufficient to draw conclusions regarding other outcomes because estimates were imprecise, risk of bias was moderate, and consistency could not be evaluated. Evidence for other treatment comparisons for CUR from obstructive causes was insufficient to conclude that one treatment was more effective than the comparison. Four small studies and one systematic review assessed treatments for CUR from nonobstructive causes. A previous systematic review provided low-strength evidence that neuromodulation improves the rate at which patients with Fowler's syndrome can be catheter free after treatment. Low-strength evidence suggested that botulinum toxin injected into the urethral sphincter may not improve PVR volumes. Two studies and one systematic review addressed CUR treatments in mixed populations or CUR from unknown causes. Evidence from original research was insufficient to conclude that one treatment was any more or less effective than another. Evidence on harms was inconsistently reported across all interventions, and no differences were detected across treatment groups; however, studies were not adequately powered to detect differences in harms across groups.

Conclusions

We identified few studies; most were small and had methodological flaws. Evidence was insufficient due to risk of bias and imprecision, and we were not able to evaluate consistency of results across studies. Further research should address conceptual issues in studying CUR as well as strengthening the evidence base with adequately powered controlled trials or prospective cohort studies for populations and interventions common in practice.