Incidence and risk factors for urinary retention in critically ill patients

Background: The removal of an indwelling urinary catheter is indicated as soon as possible to prevent complications. However, acute urinary retention is little studied among intensive care patients.

Aims: The aim of this study was to determine the incidence and risk factors for acute urinary retention after the removal of an indwelling urinary catheter in critically ill patients.

Design: This single-centre prospective study included adult critically ill adult surgical and medical patients.

Methods: All patients had an indwelling catheter for more than 48 h and indication of its removal by the attending physician. Acute urinary retention was defined as a bladder volume greater than 400 mL determined by ultrasound or intermittent urinary catheterization. A multivariate logistic regression was performed to analyse the possible risk factors for acute urinary retention.

Results: We included 85 patients from July 2014 to May 2015, most of them surgical (71·8%). Acute urinary retention occurred in 26 patients (30·6%). The use of hypnotics (midazolam or propofol given as continuous infusion) [OR 14·87 (95% CI 1·32-167·79); p = 0·029], indwelling catheterization for more than 7 days [OR 9·87 (95% CI 2·97-32·85); p < 0·001] and bed restraint [OR 9·43 (95% CI 1·07 to 83·33); p = 0·043] were all independent risk factors for acute urinary retention.

Conclusion: The incidence of acute urinary retention is high, and the main risk factors for its occurrence are prolonged use of urinary indwelling catheter, bed confinement and the use of hypnotics.

Relevance to clinical practice: Patients with risk factors should be kept under surveillance after the removal of indwelling urinary catheter for early identification of acute urinary retention and thus prevention of related complications.