Comparison of post-decompressive haematuria in rapid versus gradual bladder decompression in patients with chronic urinary retention.

Abstract

Background: Chronic urinary retention (CUR) is a common urological emergency. Initial management involves the drainage of the bladder by urethral catheterisation. Relief of CUR may be associated with post-decompressive haematuria. The two primary methods of emptying the obstructed bladder are rapid and gradual emptying. The method of relief of CUR to reduce this complication has been debated for decades.

Objective: To compare the risk of post-decompressive haematuria following rapid versus gradual urinary bladder decompression in patients with CUR.

Materials and methods: This was a prospective, randomised study in which patients with CUR were randomised into two groups: group A and group B. Group A had rapid urinary decompression with an 18 Fr urethral catheter attached to a urine bag, whereas group B had gradual decompression using a urethral catheter attached to an intravenous fluid-giving set, which was then attached to the urine bag. Post-decompressive haematuria in each group was assessed at designated times and documented based on a research protocol.

Data analysis and result presentation: Data were analysed using the Statistical Package for Social Sciences (IBM) SPSS version 21. Data were summarised by descriptive statistics. The two arms were compared for similarities in demographic variables. Continuous and categorical variables were compared using the Student's t test and Pearson's chi-square test, respectively. The results of the analysis were presented with the aid of bar charts and tables for clarity. Significant P value was ≤0.05.

Result: Sixty patients were recruited into the study and randomised into groups A (rapid urinary decompression) and B (gradual urinary decompression) with 30 patients in each arm of the study. The mean age was 70.92 ± 13.98 years (range 20-96 years). The mean age of the patients recruited into group A was 68.50 ± 14.77 years, whereas that of group B was 73.33 ± 13.19 years. The P value was 0.187. Fifteen patients (50%) developed gross haematuria in group A compared with 7 patients (23.3%) in group B with a statistically significant p value of 0.032. Four (26.7%) of the patients with gross haematuria had blood transfusions in group A, whereas only 1 (16.7%) of the patients with gross haematuria in group B had a blood transfusion. The P value was 0.920.

Conclusion: The rate of haematuria is significantly higher in group A with a higher rate of blood transfusion than that of group B. Though gradual urinary decompression is cumbersome, it is recommended to reduce the rate of haematuria and blood transfusion with its associated complications.