title: Urinary retention: benefit of gradual bladder decompression - myth or truth? A randomized controlled trial.
abstract: BACKGROUND
  Urinary retention is a common emergency requiring immediate catheterization. Gradual decompression (GD) of the extended bladder is believed to minimize the risk of complications such as bleeding or circulatory collapse, but to date it has not been compared with rapid decompression (RD) in controlled trials.
  
  
  METHODS
  Male patients presenting with urinary retention (n = 294) were randomized to rapid or gradual catheterization. For the latter, the transurethral catheter was clamped for 5 min after every 200-ml outflow until the bladder was completely empty. Patients were monitored for at least 30 min thereafter with regular checks of vital signs and presence of macroscopic hematuria.
  
  
  RESULTS
  Of 294 patients, 142 (48.3%) were randomized to the GD and 152 (51.7%) to the RD group. Both groups showed no statistically significant difference with regard to age, anticoagulation treatment, catheter size and material, or volume retained. Hematuria occurred in 16 (11.3%) of the GD and 16 (10.5%) of the RD group; 6 patients in the former and 4 in the latter required further treatment. No circulatory collapse occurred. We noted a decrease in the previously raised blood pressure and heart rate in both groups, although without clinical significance.
  
  
  CONCLUSIONS
  In this first randomized trial, no statistically significant difference was noted between gradual and rapid emptying of the bladder for urinary retention. Gradual emptying did not reduce the risk of hematuria or circulatory collapse. Therefore, there is no need to prefer gradual over rapid emptying, which is both easy and safe.
authors.affiliation: Department of Urology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany. stefanie.boettcher @ helios-kliniken.de
authors.forename: S
authors.initials: S
authors.lastname: Boettcher
authors.forename: A S
authors.initials: AS
authors.lastname: Brandt
authors.forename: S
authors.initials: S
authors.lastname: Roth
authors.forename: M J
authors.initials: MJ
authors.lastname: Mathers
authors.forename: D A
authors.initials: DA
authors.lastname: Lazica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000737:chemistry; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology; D014546:Urinary Catheterization / Q000379:methods*; D062885:Urinary Catheters; D016055:Urinary Retention / Q000628:therapy*; D055815:Young Adult
chemical_list: D000925:Anticoagulants