From the Guidelines
Chronic urinary retention requiring daily catheterizations can lead to the development of Chronic Kidney Disease (CKD) due to increased pressure on the kidneys and recurrent urinary tract infections. According to the American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline on adult neurogenic lower urinary tract dysfunction, patients with neurogenic lower urinary tract dysfunction (NLUTD) are at risk of developing urological complications, including CKD 1. The guideline recommends annual renal function assessment and upper tract imaging for patients with moderate- to high-risk NLUTD, highlighting the importance of monitoring kidney function in these patients.
The risk of developing CKD depends on several factors, including the severity and duration of retention, presence of infections, and underlying conditions. Proper catheterization technique is essential to prevent infections, and regular monitoring of kidney function through blood tests (creatinine, BUN) and imaging studies is recommended 1. Treating the underlying cause of retention when possible and ensuring complete bladder emptying are crucial preventive measures. Patients with chronic retention should maintain adequate hydration, promptly treat any urinary infections, and have regular follow-ups with both urologists and nephrologists to monitor kidney function.
Key points to consider:
- Chronic urinary retention can lead to increased pressure on the kidneys, damaging kidney tissue over time and reducing kidney function.
- Recurrent urinary tract infections can ascend to the kidneys (pyelonephritis) and cause further kidney damage.
- Proper catheterization technique and regular monitoring of kidney function are essential to prevent CKD.
- Treating the underlying cause of retention and ensuring complete bladder emptying are crucial preventive measures.
- Patients with chronic retention should maintain adequate hydration, promptly treat any urinary infections, and have regular follow-ups with both urologists and nephrologists to monitor kidney function 1.
From the Research
Relationship Between Chronic Urinary Retention and Chronic Kidney Disease
- There is limited direct evidence linking chronic urinary retention requiring daily catheterizations to the development of Chronic Kidney Disease (CKD) 2, 3, 4, 5, 6.
- However, studies suggest that urinary retention can lead to complications such as urinary tract infections and post-renal problems, which may increase the risk of developing CKD 2.
- A study on the treatment of hyperuricemia in CKD found that hyperuricemia may contribute to the development or progression of CKD, but it did not specifically address the relationship between chronic urinary retention and CKD 3.
- Another study on water intake and CKD progression found that high plain water intake was associated with faster eGFR decline in patients with CKD, but it did not investigate the effect of chronic urinary retention on CKD progression 5.
- A review on chronic urinary retention in men highlighted the lack of a clear definition and structured management for this condition, which may lead to poor treatment outcomes and increased risk of complications, including CKD 6.
Complications of Chronic Urinary Retention
- Chronic urinary retention can lead to complications such as urinary tract infections, macroscopic hematuria, and post-renal problems 2.
- A study on alpha blockers prior to removal of a catheter for acute urinary retention found that alpha blockers can increase the success rates of trial without catheter, but it did not specifically address the relationship between chronic urinary retention and CKD 4.
Definition and Management of Chronic Urinary Retention
- The definition of chronic urinary retention is imprecise and arbitrary, with different guidelines using different threshold values for postvoid residual urine volume 6.
- A systematic review on chronic urinary retention highlighted the need for internationally accepted definitions and structured management for this condition 6.