Urinary retention in a general rehabilitation unit: prevalence, clinical outcome, and the role of screening.

OBJECTIVE

To document the prevalence of, risk factors for, and outcomes of, urinary retention (UR).

DESIGN

Prospective observational study.

SETTING

A subacute general (predominantly geriatric) rehabilitation unit.

PARTICIPANTS

Three hundred nineteen consecutive patients (196 women, 123 men).

INTERVENTIONS: Twenty-two patients were catheterized for acute UR in the acute facility prior to transfer to rehabilitation. Patients admitted without catheters (n=297) had their postvoid residual (PVR) volumes assessed via a bladder scanner within 72 hours of admission.

MAIN OUTCOME MEASURE: PVR volumes of 150 mL or more were considered abnormal.

RESULTS

PVR volumes in the 297 "asymptomatic" patients were 150 mL or more in 64 (21.5%) patients. The risk of UR was greatest among male patients who had lower admission FIM instrument scores, neurologic disorders (eg, stroke or multiple sclerosis), cognitive impairment, urinary incontinence, a history of previous prostate, bladder, or voiding problems, were taking anticholinergic medications, or were immobile. Patients with UR were significantly more likely to have a urinary tract infection at admission, have urinary incontinence on discharge, and to be discharged with referrals for community services for personal care or to residential care. Although patients with UR on admission had a lower discharge FIM score, they generally showed a greater degree of improvement in their FIM scores during their stay.

CONCLUSIONS

Clinically unsuspected UR is common in patients admitted to a general rehabilitation unit. We recommend that all patients be screened for PVR on admission as an aid in bladder management.