The risk of death in men after acute urinary retention is close to that seen in patients who had a broken hip. The problem is set to get worse as the population ages, warn the researchers.

Acute urinary retention (AUR) is the sudden inability to pass urine and is often a progression of benign prostatic hyperplasia (an increase in size of the prostate in middle-aged and elderly men which can interfere with the normal flow of urine). It is a medical emergency and is thought to be linked to the presence of other disorders such as high blood pressure and diabetes.

So to investigate the risk of death associated with AUR, researchers analysed data on all men aged over 45 years who were admitted to NHS hospitals in England with a first episode of AUR between 1998 and 2005. Mortality in the first year after AUR was compared to mortality among the general male population of similar age.

During the study period, 176,046 men over 45 were admitted to hospital with primary AUR.

Mortality among these men was very high. One in seven men with spontaneous AUR (no evidence of precipitating factors other than benign prostatic hyperplasia) and one in four with precipitated AUR died in the first year.

The risk of dying increased with age and the presence of other disorders (comorbidity). Consequently, about half the men aged over 85 years with comorbid conditions died within the first year after AUR.

Overall mortality at one year in men admitted to hospital for AUR was two to three times higher than for the general male population. However, in men aged between 45 and 54 years with precipitated AUR, there was an almost 24-fold increase in mortality compared to the general population.

The authors conclude that mortality of hospitalised men with AUR is high and increases strongly with age and the presence of other conditions. As a result, patients with AUR may benefit from urgent multi-disciplinary care to identify and treat comorbidity early.

An accompanying editorial discusses the importance of this study and supports the call for multidisciplinary care in these men.

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45 per cent of the volunteers had experienced previous problems with their feet, including ulcers, callouses, bunions, corns or swelling. Despite this, 22 per cent never checked their own feet and only 29 per cent checked them daily.

Foot problems could be reduced by adults being offered foot-measuring services in shoe shops, say the researchers. They would also like to see manufacturers developing standardised shoe sizes and expanding the range of length and width fittings that they offer, especially for patients who have no feeling in their feet.

Podiatry expert Andrea Parnes, from the University of Ulster, agrees. She points out that, given the scale of the problem, it would make commercial sense for manufacturers to work with health professionals to expand their existing ranges.

In her accompanying editorial she calls for greater research into the problem, pointing out that the study also raises concerns about patients with conditions like rheumatoid arthritis.

The current issue of IJCP also includes a special supplement, which expresses support for the United Nation's resolution on diabetes and highlights practical examples that have been shown to improve diabetes care.

These range from raising government awareness worldwide to empowering patients at grassroots level.

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