Rapid Responses to:

RESEARCH: James N Armitage, Nokuthaba Sibanda, Paul J Cathcart, Mark Emberton, and Jan H P van der Meulen Mortality in men admitted to hospital with acute urinary retention: database analysis BMJ 2007; 335: 1199-1202 [Abstract] [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Cardiovascular Disease contribution to Increased Mortality after Urinary Retention

James R. Wilentz   (10 November 2007)

Common denominator in BHP and hypertension?

Svend O Mortensen   (10 December 2007)

Comorbid conditions, risk factors, and follow-up in men with acute urinary retention

Jennifer L Pikard, John Hoey   (12 December 2007)

Cause of Death in Acute Urinary Retention

Benjamin J Tinsley   (28 December 2007)

Cardiovascular Disease contribution to Increased Mortality after Urinary Retention 10 November 2007
James R. Wilentz, Associate Clinical Director of Research Lenox Hill Heart and Vascular Institute Send response to journal: Re: Cardiovascular Disease contribution to Increased Mortality after Urinary Retention	The authors have noted an increased mortality following admission for urinary retention that is greater in precipitated retention and increases with co-morbidity. It is also noted that there was a ~30% incidence of cordiovascular comorbidity. We have noted a nearly universal incidence of acute hypertension related to acute urinary rention as a clinical matter among male patients undergoing invasive cardiac procedures, and wonder whether the physiology in patients with BPH and other causes of obstructive uropathy might be such that longer term hypertension exists in these patinets and might be a significant cause of the increased mortality that you have observed. If the data exists to look back at the blood pressure recordings in these patients it might be a fruitful avenue of investigation. James R. Wilentz, MD, FACC Competing interests: None declared
Common denominator in BHP and hypertension? 10 December 2007
Svend O Mortensen, Chief urologist Urological dept. H, Herlev Hospital, 2720 Denmark Send response to journal: Re: Common denominator in BHP and hypertension?	Professor of Clinical Pharmacology in Köln, Germany, dr. Christian de Mey has pointed to the peculiar triangle of hypertension, impotence and "BPH" in ageing males: all seem related to overactivity of the alpha- adrenergic system. Alpha-blockers are nowadays not the drug of choice for hypertension, but are certainly a success in many men with Lower Urinary Tract Symptoms. Alpha-blocking agents are not in use for impotence, but noradrenaline is very often the treatment of priapism. All of this might fit together with an overactivity, but might also be explained by degeneration of the sympathetic nervous system, leading to hypersensitivity to circulating noradrenaline. Denervation hypersensitivity is known to occur in many target organs: e.g. smooth muscle cells (Cannon´s law of denervation hypersensitivity). Degeneration of parasympathetic nerves is known to cause hypersensitivity (e.g. in some neurogenic bladder dysfunctions), but probably only to cholinergic drugs (such as the infamous carbachol): circulating acetylcholine is virtually non-exsistent due to wide-spread occurrence of cholinesterases in blood. Competing interests: None declared
Comorbid conditions, risk factors, and follow-up in men with acute urinary retention 12 December 2007
Jennifer L Pikard, MSc Candidate School of Health Studies, PEC Room 223, 69 Union St, Queen’s University, Kingston, Ontario, K7L 3N6, John Hoey Send response to journal: Re: Comorbid conditions, risk factors, and follow-up in men with acute urinary retention	In this study, mortality in men admitted to hospital with acute urinary retention was associated with age and co-morbidity, as one would expect. As at least a third of men had a Charlson score of 1 or greater, it would be of great interest to explore further the associations with co- morbidity. Perhaps stratification of these men into groupings based on number of comorbid diseases may be worth mentioning and could be further applied to the increased risk of death in the general population. A follow-up on existence of other risk factors for BPH in relation to a higher susceptibility to comorbid conditions or death (i.e. chronic pulmonary disease) may also be of interest to the authors. Perhaps a table showing the SMRs for each item in the Charlson score may benefit the exploration and further contribution of this research. Competing interests: None declared
Cause of Death in Acute Urinary Retention 28 December 2007
Benjamin J Tinsley, 4th Year Medical Student Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD Send response to journal: Re: Cause of Death in Acute Urinary Retention	Dear Sirs, Although your article clearly illustrates the fact that acute urinary retention causes increased mortality in men of all age groups and that comorbidity contributes to higher death rates, there is no mention of the most common causes of death. Untreated urinary retention can result in renal failure or bladder rupture which are often fatal, and I assume these are the main causes of death in the cohort without comorbidity. However, although the main comorbidities with those presenting with acute urinary retention were mentioned (cardiovascular disease, diabetes etc), no mention was made of how those comorbidities contributed to death. In the cohort with comorbidity, was the main cause of death complications of urinary retention, or the other disease(s) present? If those with cardiovascular disease and diabetes had died from complications of those diseases, the contribution of urinary retention to death rates will obviously be less severe than presented here. Yours Faithfully, Benjamin J Tinsley 4th Year Medical Student Barts and The London School of Medicine and Dentistry ha03296@qmul.ac.uk Competing interests: None declared