Urinary Retention in the Elderly: A Study of 100 Hospitalized Patients

OBJECTIVE: To estimate the prevalence of incomplete bladder emptying by the elderly and to determine its significance and its relationship to overflow incontinence. DESIGN: Survey comparing groups with and without incomplete bladder emptying. SETTING: A geriatric hospital ward. PATIENTS: One hundred patients who were consecutively admitted, with an average age of 82.6 years. MEASUREMENTS: A physical examination, perineal examination, micturition assessment, and evaluation of the post-voiding residual urine volume (PRUV) by ultrasonography at day 1 and day 8 following admission. One-channel cystometry and urine cultures were also done. Between-group comparison was performed between groups R (ie, PRUV greater than 50 mL) and C (ie, PRUV less than 50 mL). MAIN RESULTS: The prevalence of PRUV greater than 50 mL was 34%. Group R patients presented with greater dependency; death was the final outcome of hospitalization in 36% of these cases (vs only 9% in group C). A high PRUV was not correlated with urinary tract infection or renal failure, but there was a strong, almost significant trend toward incontinence being more prevalent in R (57%) than in C (38%) (P = 0.06). Group R presented a hypotonic bladder in 45% of cases, evidenced by cystometry, versus 6% in group C. CONCLUSIONS: In cases with a high PRUV, the utmost caution is necessary both in the diagnosis of overflow incontinence and in establishing a therapeutic approach. Incomplete bladder emptying is associated with a poor prognosis.