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In Vivo Luminal Measurement of Distension-Evoked Urothelial ATP Release in Rodents

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Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.

Kristin Chrouser^1,2, Karen E Fowler², Jason D Mann³

¹Department of Urology, University of Michigan, Ann Arbor.

JAMA Network Open

|July 16, 2024

Summary

A new algorithm helps manage acute urinary retention (UR) in hospitalized adults. It guides appropriate use of bladder scanners and catheterization, improving patient safety and care.

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Area of Science:

Urology
Healthcare Management
Clinical Informatics

Background:

Acute urinary retention (UR) is a common clinical issue.
Variations in diagnosis and management of UR can lead to patient harm.
There is a need for standardized protocols for UR management in hospitals.

Purpose of the Study:

To develop a clinical algorithm for the screening and management of acute urinary retention (UR) in adult inpatients.
To standardize the diagnostic and therapeutic approaches to UR.
To improve patient safety and reduce harm associated with UR management.

Main Methods:

A mixed-methods approach was employed, combining the RAND/UCLA Appropriateness Method with qualitative interviews.
An 11-member multidisciplinary expert panel developed an initial algorithm based on 107 clinical scenarios.
Thirty-three frontline clinicians provided feedback on the draft algorithm through semistructured interviews to inform refinements.

Main Results:

The developed algorithm prioritizes bladder scanners over immediate catheterization for UR diagnosis.
Specific bladder scanner volume thresholds (≥300 mL symptomatic, ≥500 mL asymptomatic) were established for prompting catheterization.
Intermittent catheterization is preferred over indwelling catheterization for lower bladder volumes.
Frontline clinicians found the evidence-based protocol needed, emphasizing simplicity, graphical appeal, and EMR integration.

Conclusions:

A systematic, multidisciplinary approach yielded a UR evaluation and catheterization algorithm.
The algorithm aims to enhance patient safety by optimizing the use of bladder scanners and catheterization.
This evidence- and expert opinion-based tool provides practical guidance for managing adult UR in inpatient settings.