|Year : 2021 | Volume
| Issue : 2 | Page : 179-181
Sodium abnormalities in patients with acute retention of urine due to bladder outlet obstruction
Riju Joseph Paul1, VP Muhammed Farooq2, NM Mujeeb Rahman2
1 Department of General Surgery, MES Medical College, Kolathur, Kerala, India
2 Department of Surgery, MES Medical College, Kolathur, Kerala, India
|Date of Submission||28-Jul-2021|
|Date of Decision||05-Sep-2021|
|Date of Acceptance||06-Sep-2021|
|Date of Web Publication||15-Nov-2021|
Dr. Riju Joseph Paul
Department of General Surgery, MES Medical College, Perinthalmanna, Kolathur - 679 322, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Bladder outlet obstruction is the most common cause of urinary retention. Electrolyte disturbances are among one of the most overlooked counterparts of urinary retention. Reports suggest that acute urinary retention can lead to derangements in sodium levels. Objective: The objective of the study was to find out the incidence of sodium abnormalities in patients admitted with urinary retention due to bladder outlet obstruction. To compare serum sodium levels before and after relief of bladder outlet obstruction in these patients. Materials and Methods: This is a prospective, observational study design. All patients above 18 years who presented with complaints of acute retention of urine due to bladder outlet obstruction and fulfilled the inclusion and exclusion criteria were included in the study. After history and physical examination, a urinary catheter was placed to empty the bladder. Serum sodium levels were checked before catheterisation, at 24 h and 48 h after catheterisation to note if there is a change in values of serum sodium. Results: There were 92 cases of acute urinary retention, of which 88 were male and 4 were female. The mean serum sodium value at the time of catheterisation was 131.64, at 24 h after catheterisation was 133.48 and 48 h later was 134.95. Conclusion: An increase in serum sodium levels was noted in the majority of the patients who were catheterised. We infer that hyponatraemia is seen in acute urinary retention and that it gets corrected on catheterisation.
Keywords: Acute urine retention, bladder outlet obstruction, sodium retention
|How to cite this article:|
Paul RJ, Muhammed Farooq V P, Mujeeb Rahman N M. Sodium abnormalities in patients with acute retention of urine due to bladder outlet obstruction. Kerala Surg J 2021;27:179-81
|How to cite this URL:|
Paul RJ, Muhammed Farooq V P, Mujeeb Rahman N M. Sodium abnormalities in patients with acute retention of urine due to bladder outlet obstruction. Kerala Surg J [serial online] 2021 [cited 2021 Nov 29];27:179-81. Available from: http://www.keralasurgj.com/text.asp?2021/27/2/179/330401
| Introduction|| |
Urinary retention is a common clinical condition addressed in both primary health care clinics and hospitals. Bladder outlet obstruction is the most common cause of urinary retention. hyponatraemia occurs at any age but is most common at the extremes of age. The explanations given for the frequent occurrence of hyponatraemia in the elderly are the age-related physiological changes: A decrease in glomerular filtration rate that is accompanied by limited sodium conservation, a decrease in total body water, reduced diluting capacity by the aged kidney, hyper-responsiveness to arginine-vasopressin and frequent use of medications. Hyponatraemia is defined as a serum sodium level of <135 mmol/L. Significant hyponatraemia is considered as a sodium value of <125 mmol/L. There are some clinical conditions that lead to hyponatraemia in elderly patients. The most common causes are the syndrome of inappropriate antidiuretic hormone secretion (SIADH), congestive heart failure, water overload, post-operative state as well as treatment with various medications such as the thiazides and the selective serotonin reuptake inhibitors.
Reports suggest that urinary retention can lead to derangements in sodium levels and hence, urinary retention may be a rare cause of hyponatraemia. Association of bladder distention and hyponatraemia is considered to be due to SIADH or the release of vasopressin triggered by pain due to bladder distention. In this study, we consider the association of hyponatraemia in patients presenting with complaints of acute retention of urine due to bladder outlet obstruction.
| Materials and Methods|| |
We aimed to find out the incidence of sodium abnormalities in patients admitted with urinary retention due to bladder outlet obstruction and to compare serum Sodium levels before and after relief of bladder outlet obstruction in these patients. It was a prospective, observational study from January to December 2018 on patients presenting to the Department of Urology and Department of General Surgery with complaints of acute retention of urine. The sample size was calculated using 4pq/d2 where P = 6.1% from the study conducted by Galperin et al. as 92. Bladder outlet obstruction is diagnosed by a palpable bladder, post-void bladder ultrasound demonstrating residual urine volume more than 500 ml in partial bladder outlet obstruction or drainage of more than 1000 ml after catheterisation in complete bladder obstruction. All patients ≥18 years, presenting with acute retention of urine were included. Patients who did not consent, patients with acute on chronic retention of urine, those with acute retention not due to bladder outlet obstruction, significant hyponatraemia (Na <125), symptomatic hyponatraemia or hyponatraemia due to other causes were excluded. After history taking and physical examination for palpable bladder and a rectal examination to assess the prostate size and rectal tone, complete urinary retention was confirmed by the placement of a urinary catheter and draining more than 1000 ml of urine. On admission, a urinary catheter was placed to empty the bladder. Serum sodium levels were checked before catheterisation, at 24 h and 48 h after catheterisation to note if there is a change in values of serum sodium. Written informed consent was taken from all patients. Institutional ethical clearance was obtained. Mean Sodium levels before and after relief of bladder obstruction were entered in Microsoft Excel and analysed using IBM SPSS software version 21 (IBM SPSS Statistics, Software version 21.0, USA, 2020). The significance of the difference between the pre- and post-catheterisation serum sodium levels was looked for using Paired t-test.
| Results|| |
The study group consisted of 92 patients. 88 were male and 4 were female. The mean age was 68.09 ± 11.4 years; males had a higher mean age of 68.7 ± 10.9 years when compared to 53.0 ± 13.4 years for females. He age- and gender-wise distribution showed males were higher in the age group 61–70 years (35.2%), females were highest and only a few in the age group 51–70 years [Table 1].
82 (89.1%) of the patients had retention for 1 day and the rest 10 (10.9%) had retention for 2 days. Symptoms of hyponatraemia were present only in 4 patients, who were disoriented. All the patients were conscious. Various lower urinary tract symptoms were noted. All the patients had a palpable bladder and all the male patients had palpable prostate (96%). All patients had difficulty in urination and 94% had abdominal pain along with straining on micturition [Table 2].
|Table 2: Distribution of the study subjects based on lower urinary tract symptoms|
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The volume of urine on catheterisation varied from 400 to 1200 ml is detailed in [Table 3]. Majority had urine drained <700 ml.
|Table 3: Distribution of the study subjects based on volume of urine at the time of catheterisation|
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The mean sodium value at the time of catheterisation was131.64 ± 5.2 mEq/L, at 24 h 133.48 ± 4.0 and at 48 h after catheterisation 134.95 ± 3.2 [Figure 1]. The Friedman's test value was 64.573; d.f 2 and P < 0.001, which is statistically highly significant. At the time of catheterisation, 25 patients had normal serum sodium levels. The number of patients with normal sodium levels increased to 58 at 48 h after catheterisation. Chi-square test was done with a degree of freedom of 2 and test value of 24 and P < 0.001 obtained which was also found to be statistically significant [Figure 2].
|Figure 1: Sodium values at the time of catheterisation, 24 h and 48 h after catheterisation|
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|Figure 2: Serum sodium levels at catheterisation, 24 and 48 h after catheterisation|
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| Discussion|| |
Hyponatraemia is primarily a disorder of water balance or water distribution, with SIADH as one of the causes. SIADH is characterised by the activation of water-conserving mechanisms despite the absence of osmotic or volume-related stimuli. Since the renal response to volume expansion remains intact, these patients are typically euvolemic.
SIADH often runs a benign course in the elderly and has little clinical significance. However, because of the rise in total body water, serum concentrations of sodium are decreased. Hence, the elderly may be at increased risk of developing symptomatic hyponatraemia with intercurrent illnesses.
Hyponatraemia may be associated with urinary retention., The probable mechanism postulated for hyponatraemia is that bladder distention can trigger the release of vasopressin from the pituitary either by itself or as a response to pain.,
Hence, in our cases, the association of bladder distention and hyponatraemia was considered. Hyponatraemia was corrected rapidly subsequent to urinary catheterisation.,, Various metabolic causes have been postulated for the causes of hyponatraemia and other electrolyte disturbances during acute retention of urine.,,, We found an increase in serum sodium values on serial monitoring after catheterisation in patients with acute retention. This was supported by a various studies,,, suggesting urinary retention alone as a cause of hyponatraemia.
| Conclusion|| |
We have observed 92 cases of acute urinary retention, of which 88 were male and 4 were female and a few of them had hyponatraemia. An increase in serum sodium levels were noted in majority of the patients who were catheterised and it was found to be statistically significant. From which we can infer that hyponatraemia is seen in acute urinary retention and that it get corrected by itself on relieving the obstruction.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]