What are the effects of urinary retention due to cord compression?

From the Guidelines

Urinary retention due to cord compression is a medical emergency that requires immediate attention to prevent permanent neurological damage and chronic bladder dysfunction. The effects of urinary retention due to cord compression can be severe and long-lasting, emphasizing the need for prompt intervention.

• The primary concern is the potential for permanent neurological deficits, including paralysis and chronic bladder dysfunction, if treatment is delayed 1.
• High-dose corticosteroids, such as dexamethasone, are typically administered to reduce inflammation around the spinal cord, with an initial dose of 10-100mg IV followed by 4-24mg daily in divided doses.
• Urgent surgical decompression may be necessary to relieve pressure on the spinal cord and prevent permanent damage.
• Urinary catheterization will likely be performed to relieve bladder distension while awaiting definitive treatment.
• The underlying cause of cord compression, such as tumor, herniated disc, abscess, or trauma, will determine the specific treatment approach.
• In some cases, the use of alpha-blockers, such as tamsulosin or alfuzosin, may be considered to help manage urinary retention, but this should be done with caution and only in patients without a history of alpha-blocker side effects or unstable medical comorbidities 1.
• The connection between urinary retention and cord compression occurs because spinal cord injury disrupts the normal neural pathways controlling bladder function, resulting in the inability to voluntarily urinate despite a full bladder.

From the FDA Drug Label

Effect on Acute Urinary Retention and the Need for Surgery In A Long-Term Efficacy and Safety Study, efficacy was also assessed by evaluating treatment failures Treatment failure was prospectively defined as BPH-related urological events or clinical deterioration, lack of improvement and/or the need for alternative therapy. BPH-related urological events were defined as urological surgical intervention and acute urinary retention requiring catheterization.

The following table (Table 5) summarizes the results. Patients (%)* Event Placebo N=1503 Finasteride N=1513 Relative Risk† 95% CI P Value† Table 5: All Treatment Failures in A Long-Term Efficacy and Safety Study All Treatment Failures 37.1 26.2 0.68 (0.57 to 0.79) <0.001 Surgical Interventions for BPH 10.1 4.6 0.45 (0.32 to 0.63) <0.001 Acute Urinary Retention Requiring Catheterization 6.6 2.8 0. 43 (0.28 to 0.66) < 0.001

The effects of urinary retention due to cord compression are not directly addressed in the provided drug label. However, the label does discuss acute urinary retention in the context of BPH, which may be related to, but is not the same as, urinary retention due to cord compression.

• Acute urinary retention is defined as a BPH-related urological event requiring catheterization.
• The study found a 57% reduction in risk of acute urinary retention in patients treated with finasteride compared to placebo [6.6% for placebo vs 2.8% for finasteride; 95% CI: (34 to 72%)] 2. However, this information does not directly answer the question about the effects of urinary retention due to cord compression.

From the Research

Effects of Urinary Retention due to Cord Compression

• Urinary retention due to cord compression can lead to permanent hypotonic bladders and lower extremity paresis 3
• Acute urinary retention (AUR) is usually easy to identify and treat, but if left untreated, it can lead to kidney damage or urosepsis, compromising the patient's life 4
• Chronic urinary retention (CUR) is often more difficult to identify and can lead to increased post-void residual urine (PVR), making it a hidden condition 4
• The mainstay for treatment in the acute setting is Foley catheter placement, and starting alpha-blockers in men can increase voiding trial success 5
• Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization, and further management is decided by determining the cause and chronicity of the urinary retention 6

Causes and Risk Factors

• Spinal cord compression can present with acute urinary retention as a sign, and patients may have previously diagnosed carcinoma or a history compatible with prostatic hypertrophy 3
• Age, benign prostatic hyperplasia, and lower urinary tract symptoms are patient factors that predispose to retention 5
• Surgery-related factors, such as operative time, intravenous fluid administration, type of anesthesia, and procedure type, can also contribute to urinary retention 5

Treatment and Management

• Transurethral prostatectomy is considered the gold standard for treatment of chronic retention 5
• Alpha blockers can help delay surgery and may avoid surgery altogether in a subgroup of patients 7
• Anticholinergics can be safely combined with alpha blockers in symptomatic BPH patients without increasing the risk of AUR 7
• Suprapubic catheters can improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term 6