title: A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture.
abstract: OBJECTIVE
  To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting.
  
  
  METHODS
  We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management.
  
  
  RESULTS
  We identified 4794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6 ± 0.8 years. A total of 4084 (85%) men received urethral dilation, whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P <.001), treated in recent years (P = .002), and in hospitals in the West region (P = .003). In multivariate analysis, SPT placement was significantly associated with younger age (P = .004), public insurance (P = .03), recent treatment years (P = .02), and hospitals in the West region (P = .02). Income and hospital teaching status did not have significant association with initial treatment choice.
  
  
  CONCLUSIONS
  Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend toward SPT placement. Patients who are younger, publicly insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC. Electronic address: Michael.Granieri@duke.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Granieri
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Hsin-Hsiao S
authors.initials: HS
authors.lastname: Wang
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D015331:Cohort Studies; D016208:Databases, Factual; D004106:Dilatation; D004636:Emergency Service, Hospital; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D014525:Urethral Stricture / Q000150:complications / Q000628:therapy*; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy*