[3] Acute Urinary Retention Flashcards
What is acute urinary retention?
The sudden inability to pass urine
Is acute urinary retention painful?
Usually
What does acute urinary retention require?
Emergency treatment with a urinary catheter
What are the categories of causes of acute urinary retention?
- Obstructive
- Infectious and inflammatory
- Drug related
- Neurological
- Other
- Post-operative
What are the obstructive causes of urinary retention in men?
- Benign prostatic hyperplasia
- Meatal stenosis
- Paraphismosis
- Penile constricting bands
- Phismosis
- Prostate cancer
What are the obstructive causes of urinary retention in women?
- Prolapse
- Pelvic mass
- Retroverted gravid uterus
What kinds of prolapse can cause urinary retention?
- Cystocele
- Rectocele
- Uterine
Give three examples of pelvic masses in women that can cause obstructive urinary retention
- Gynaecological malignancy
- Uterine fibroid
- Ovarian cyst
What are the obstructive causes of urinary retention in both genders?
- Bladder calculi
- Bladder cancer
- Faecal impaction
- Gastrointestinal or retroperitoneal malignancy
- Urethral strictures
- Foreign bodies
- Stones
What are the infectious and inflammatory causes of urinary retention in men?
- Balantitis
- Prostatitis
- Prostatic abscess
What are the infectious and inflammatory causes of urinary retention in women?
- Acute vulvovaginitis
- Vaginal lichen planus and lichen sclerosis
What are the infectious and inflammatory causes of urinary retention in both genders?
- Cystitis
- Herpes simplex virus
- Peri-urethral abscess
- Varicella-zoster virus
What % of cases of acute urinary retention episodes are thought to be attributable to drugs?
10%
What drugs are known to increase the risk of acute urinary retention?
- Anticholinergics
- Opioids and anaesthetics
- Alpha-adenoceptor agonists
- Benzodiazepines
- NSAIDs
- Detrusor relaxants
- Calcium-channel blockers
- Anti-histamines
- Alcohol
What kind of retention do neurological problems cause?
More often cause chronic retention, but may also cause acute retention
What are the categories of neurological causes of acute urinary retention?
- Autonomic and peripheral nerve pathologies
- Brain
- Spinal cord
What autonomic or peripheral nerve pathologies can cause acute urinary retention?
- Autonomic neuropathy
- Diabetes mellitus
- Guillain-Barre syndrome
- Pernicious anaemia
- Poliomyelitis
- Radical pelvic surgery
- Spinal cord trauma
What brain conditions can cause acute urinary retention?
- CVD
- Multiple sclerosis
- Neoplasm
- Normal pressure hydrocephalus
- Parkinson’s disease
What spinal cord conditions can cause acute urinary retention?
- Intervertebral disc disease
- Meningomyelocele
- MS
- Spina bifida
- Spinal cord trauma
- Spinal stenosis
- Transverse myelitis
- Tumours
- Cauda equine
What are the other causes of urinary retention in men?
Penile trauma, fracture, or laceration
What are the other causes of urinary retention in females?
- Post-partum complications
- Urethral sphincter dysfunction
What are the other causes of acute urinary retention in both genders?
- Pelvic trauma
- Iatrogenic
- Psychogenic
What are the post-operative causes of acute urinary retention?
- Pain
- Traumatic instrumentation
- Bladder over-distention
- Iatrogenic
- Drugs
- Decreased mobility and increased bed rest
What features make a diagnosis of acute urinary retention usually self-evident?
The patient is very uncomfortable and unable to pass urine, with a tender, distended bladder
What should history and examination be aimed at in acute urinary retention?
Determining a cause
What information should be obtained from the history in AUR?
- Nature and duration of current symptoms
- Any other associated symptoms, including fever, weight loss, sensory loss, weakness
- Enquire regarding previous episodes of retention and LUTS
- Consider precipitants
- PMH
- Medications
What are the potential precipitants for AUR?
- Alcohol consumption
- Recent surgery
- UTI
- Constipation
- Large fluid intake
- Cold exposure
- Prolonged travel
What should be included in the examination for AUR?
- Look for signs of fever, and signs of infection/systemic illness
- Abdominal examination
- Genitourinary examination
- PR examination
- Neurological examination
What may be found on abdominal examination in AUR?
Tender and enlarged bladder with dullness to percussion well above pubic symphysis, often almost to level of umbilicus
What should be looked for in men on genitourinary examination in AUR?
- Phismosis or meatal stenosis
- Urethral discharge and genital vesicles
What should be looked for on genitourinary examination in women?
- Vulval or vaginal inflammation or infection
- Cystocele, rectocele, or uterine prolapse
- Pelvic mass
What should be checked for on PR examination in AUR?
- Anal tone
- Prostatic size
- Nodules
- Tenderness
What may be excluded on PR examination in AUR?
Faecal impaction
RWhat should be looked for on neurological examination in AUR?
- Evidence of a prolapsed disc or cord compression by checking lower limb power
- Check perineal sensation
How can you differentiate between acute and chronic urinary retention?
AUR is usually painful. CUR tends to be relatively pain free
What investigations are done in AUR?
- Urinanalysis
- MSU
- Blood tests
- Imaging studies
What should be checked for on urinalysis in AUR?
- Infection
- Haematuria
- Proteinuria
- Glucosuria
What blood tests should be in AUR?
- FBC
- U&E
- Creatinine
- eGFR
- Blood glucose
- PSA
What imaging studies may be done in AUR?
- Ultrasound
- CT scan
- MRI/CT brain scan
- MRI scan of spine
- Cystoscopy
What is the use of ultrasound in AUR?
- Provides a measure of post-void residual urine
- Looks for hydronephrosis and other structural abnormalities of the renal system
What is the use of CT scan in AUR?
Used to look for pelvic, abdominal, or retroperitoneal mass causing extrinsic bladder neck compression
What is the use of MRI/CT brain scan in AUR?
Looks for intracranial lesions
What is the purpose of MRI scan of spine in AUR?
Looks for disc prolapse, cauda equina syndrome, spinal cord compression, or MS
How is AUR managed?
Immediate and complete bladder decompression wiht immediate catheteristation
What medication should be offered before removal of catheter in AUR?
An alpha-blocker
What does secondary management of AUR involve?
Treatment of underlying cause
What are the complications of AUR?
- UTIs
- AKIs
- Post-obstructive diuresis
- Post-retention haematuria
