Screening in men could reduce urinary retention mortality rates

Nurses should screen men with benign prostatic hyperplasia (BPH) for co-morbidities to prevent them from going into acute urinary retention (AUR), according to the authors of a UK study.

Nurses should screen men with benign prostatic hyperplasia (BPH) for co-morbidities to prevent them from going into acute urinary retention (AUR), according to the authors of a UK study.

AUR is a severe complication of BPH and over one-quarter of men admitted to hospital with this will die within a year, the London researchers say.

Over a seven-year period, they studied 176,046 men aged over 45 who were admitted to hospital with primary AUR.

One in seven men with spontaneous AUR – no precipitating factors other than BPH – died within the first year, as did one in four with precipitated retention triggered by an event indicating a co-morbid condition. About half of these deaths occurred within the first 90 days.

The authors said more than one-third of the men with AUR had at least one major co-morbidity and that screening men with lower urinary tract symptoms attributable to BPH would reduce mortality.

But Karen Hopkins, urology nurse practitioner at the Countess of Chester Foundation Trust in Cheshire, warned that blanket screening was not practical.

'At our nurse-led lower urinary tract symptom clinics, we already take a full medical history. Screening for all co-morbidities would be impossible, so we would need to know more specifically what conditions we would be looking for,' she said.

Sharon Clovis, prostate clinical nurse specialist at Guy's and St Thomas' NHS Foundation Trust in London, added that screening would require significant resources and increased nurse training.

'A nurse would need an advanced assessment skills course,' she said. 'We would also have to refer patients to a special clinic – it is unlikely that nurses would be able to fit the work into their schedules.'

BMJ Online First (2007) www.bmj.com