1: Acute and Chronic Urinary Retention Flashcards
What is acute urinary retention
Inability to pass urine
In which gender does urinary retention tend to occur
Males (13:1)
Why is urinary retention more common in men
Secondary to BPH
Describe incidence of urinary retention with age
Increases
What are the 4 etiological categories of urinary retention
- Urethral obstruction
- Medications
- Neurological
- Infection/Women
What is the most common etiological category of urinary retention
Obstruction
What are 5 causes of urethral obstruction
- BPH
- Urethral stricture
- Calculi
- Malignancy
- Constipation
What is a cause of acute retention in male children
Posterior urethral valves
What medications can cause urinary retention
Anti-cholinergics
Anti-histamines
Opioids
Benzodiezapines
What are 5 autonomic causes of acute urinary retention
- MS
- SCC
- Stroke
- PD
- Damage to pelvic splanchnic nerves
- Diabetic autonomi neuropathy
What are symptoms of acute urinary retention
Suprapubic pain
Inability to void
What are two signs of acute urinary retention
Suprapubic tenderness
Palpable bladder
What exam should both men and women have in acute urinary retention
Rectal
Neurological
What exam should women also receive in acute urinary retention
Pelvic exam
What is first line investigation/management for urinary retention
Trans-urethral catheter
What type of catheterisation is trialled first
Trans-Urethral
If trans-urethral catheter does not work what is placed
Supra-pubic
Explain transurethral catheterisation as an investigation for urinary retention
The amount of water drained in 15-minutes is measured.
What does drainage of less than 200ml suggest
No urinary retention
What does drainage of more than 400ml suggest
Urinary retention
What does drainage 200-400ml indicate
Depends on cause
What other investigations may be ordered routinely in acute urinary retention
- Urinalysis
- Urine MC+S
- U+E
- CRP
- FBC
Why should PSA not be ordered in urinary retention even in BPH suspected
As PSA is raised in urinary retention
In MS if someone has bladder dysfunction what is ordered
Bladder USS
In MS if residual volume is more than 500ml what is done
Intermittent self-catheterisation
In MS if residual volume is less than 500ml what is done
Anti-cholinergics
How does NICE define chronic urinary retention
Volume more than 1000ml on post-void bladder scan
How do you determine residual volume
Post-void residual bladder volume
In which gender is chronic retention more common
Male
How is chronic urinary retention divided
Functional
Mechanical
What are the 3 mechanical categories of chronic urinary retention
- Urethral
- Bladder
- Enlarged prostate
What is the most common cause of chronic retention
BPH
What can cause urethral narrowing
Urethral stricture
TCC
What can cause bladder neck obstruction
TCC
What causes functional chronic urinary retention
Neurological
Medication
What are neurological causes of chromic urinary retention
- Injury to pelvic splanchnic nerves
- MS
- Stroke
- Diabetes
What are drug-induced causes of chronic urinary retention
- Anti-cholinergic
- Calcium channel blockers
How does chronic urinary retention present clinically
- Painless inability to void urine
- Overflow incontinence
- New-onset enuresis
Why may a new-onset enuresis occur
As pressure of urethral sphincter is lower at night which can cause fluid to leak
How can acute urinary retention be distinguished from chronic urinary retention
- Acute = painful
- Chronic = painless
What is acute-on-chronic retention
Individual with chronic retention who presents with painful inability to pass urine
How does acute-on-chronic retention present
Painful inability to void with catheterisation volume >800mL
What investigations are ordered in chronic urinary retention
- DRE (All males)
- Neurological exam
- Urinalysis
- MSU
- U+E (Creatinine)!
- Renal USS (Hydronephrosis)!
What should be checked for particularly in chronic retention
Creatinine (U+E)
Hydronephrosis (USS)
If individual has raised creatinine or hydronephrosis, how should they be managed
Intermittent self-catheterisation or indwelling catheter
If individual does not have raised creatinine or hydronephrosis but has bothersome LUTS what is considered
TURP
If no bothersome LUTS how is the individual monitored
Active monitoring with
- Renal USS for hydronephrosis
- U+E for creatinine
- Post-residual bladder scan for post-void
What are 3 complications of chronic retention
- Acute-on-chronic
- UTI
- Hydronephrosis
What are 4 causes of urethral stricture
- STI
- Lichen sclerosis (Balanitis Xeotica obliterates)
- Catheterisation
- hypospadias
