Routine ultrasound in acute retention of urine

OBJECTIVE: To evaluate the frequency of urological abnormalities in routine urinary tract ultrasonography (renal and pelvic) in patients with urinary retention secondary to benign prostatic hyperplasia.

METHODS: All patients presented to Salmaniya Medical Complex, Bahrain with acute retention of urine secondary to benign prostatic hyperplasia (BPH) in the period between January 2001 and December 2001 were included. The frequency of urological abnormalities, other than BPH, was obtained.

RESULTS: One hundred patients were enrolled with a mean age of 67 years. Forty-one patients (41%) had other urological abnormalities. Among these, 3 cases of malignancy were discovered incidentally. A case of renal cell carcinoma, which was completely excised, and 4 cases of bladder tumor, 2 were new cases and 2 were previously known cases of cancer bladder. Other urological abnormalities were renal stones (9 cases), renal cysts (9 cases), hydronephrosis (14 cases) and bladder stones (5 cases). Asymptomatic non-urological abnormalities were gallstones (3 cases), liver cirrhosis (one case) and hepatic hemangioma (one case). Renal impairment was found in 18% of all patients and 80% with hydronephrosis. Four patients had hypoechoic nodules, and all had cancer prostate.

CONCLUSION: Significant fraction of patients with acute urinary retention due to BPH have another pathology; although the majority are trivial and it did not influence the immediate management, some are life threatening such as renal cell carcinoma and bladder tumor. Hydronephrosis can be missed if one depends solely on renal biochemistry. Thus, routine evaluation of such patients with pelvic and renal ultrasonography is justified.