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A - MSRA Renal and Urinary [17] > [3] Acute Urinary Retention > Flashcards

[3] Acute Urinary Retention Flashcards

1
Q

What is acute urinary retention?

A

The sudden inability to pass urine

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2
Q

Is acute urinary retention painful?

A

Usually

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3
Q

What does acute urinary retention require?

A

Emergency treatment with a urinary catheter

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4
Q

What are the categories of causes of acute urinary retention?

A
  • Obstructive
  • Infectious and inflammatory
  • Drug related
  • Neurological
  • Other
  • Post-operative
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5
Q

What are the obstructive causes of urinary retention in men?

A
  • Benign prostatic hyperplasia
  • Meatal stenosis
  • Paraphismosis
  • Penile constricting bands
  • Phismosis
  • Prostate cancer
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6
Q

What are the obstructive causes of urinary retention in women?

A
  • Prolapse
  • Pelvic mass
  • Retroverted gravid uterus
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7
Q

What kinds of prolapse can cause urinary retention?

A
  • Cystocele
  • Rectocele
  • Uterine
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8
Q

Give three examples of pelvic masses in women that can cause obstructive urinary retention

A
  • Gynaecological malignancy
  • Uterine fibroid
  • Ovarian cyst
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9
Q

What are the obstructive causes of urinary retention in both genders?

A
  • Bladder calculi
  • Bladder cancer
  • Faecal impaction
  • Gastrointestinal or retroperitoneal malignancy
  • Urethral strictures
  • Foreign bodies
  • Stones
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10
Q

What are the infectious and inflammatory causes of urinary retention in men?

A
  • Balantitis
  • Prostatitis
  • Prostatic abscess
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11
Q

What are the infectious and inflammatory causes of urinary retention in women?

A
  • Acute vulvovaginitis
  • Vaginal lichen planus and lichen sclerosis
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12
Q

What are the infectious and inflammatory causes of urinary retention in both genders?

A
  • Cystitis
  • Herpes simplex virus
  • Peri-urethral abscess
  • Varicella-zoster virus
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13
Q

What % of cases of acute urinary retention episodes are thought to be attributable to drugs?

A

10%

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14
Q

What drugs are known to increase the risk of acute urinary retention?

A
  • Anticholinergics
  • Opioids and anaesthetics
  • Alpha-adenoceptor agonists
  • Benzodiazepines
  • NSAIDs
  • Detrusor relaxants
  • Calcium-channel blockers
  • Anti-histamines
  • Alcohol
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15
Q

What kind of retention do neurological problems cause?

A

More often cause chronic retention, but may also cause acute retention

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16
Q

What are the categories of neurological causes of acute urinary retention?

A
  • Autonomic and peripheral nerve pathologies
  • Brain
  • Spinal cord
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17
Q

What autonomic or peripheral nerve pathologies can cause acute urinary retention?

A
  • Autonomic neuropathy
  • Diabetes mellitus
  • Guillain-Barre syndrome
  • Pernicious anaemia
  • Poliomyelitis
  • Radical pelvic surgery
  • Spinal cord trauma
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18
Q

What brain conditions can cause acute urinary retention?

A
  • CVD
  • Multiple sclerosis
  • Neoplasm
  • Normal pressure hydrocephalus
  • Parkinson’s disease
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19
Q

What spinal cord conditions can cause acute urinary retention?

A
  • Intervertebral disc disease
  • Meningomyelocele
  • MS
  • Spina bifida
  • Spinal cord trauma
  • Spinal stenosis
  • Transverse myelitis
  • Tumours
  • Cauda equine
20
Q

What are the other causes of urinary retention in men?

A

Penile trauma, fracture, or laceration

21
Q

What are the other causes of urinary retention in females?

A
  • Post-partum complications
  • Urethral sphincter dysfunction
22
Q

What are the other causes of acute urinary retention in both genders?

A
  • Pelvic trauma
  • Iatrogenic
  • Psychogenic
23
Q

What are the post-operative causes of acute urinary retention?

A
  • Pain
  • Traumatic instrumentation
  • Bladder over-distention
  • Iatrogenic
  • Drugs
  • Decreased mobility and increased bed rest
24
Q

What features make a diagnosis of acute urinary retention usually self-evident?

A

The patient is very uncomfortable and unable to pass urine, with a tender, distended bladder

25
Q

What should history and examination be aimed at in acute urinary retention?

A

Determining a cause

26
Q

What information should be obtained from the history in AUR?

A
  • 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
27
Q

What are the potential precipitants for AUR?

A
  • Alcohol consumption
  • Recent surgery
  • UTI
  • Constipation
  • Large fluid intake
  • Cold exposure
  • Prolonged travel
28
Q

What should be included in the examination for AUR?

A
  • Look for signs of fever, and signs of infection/systemic illness
  • Abdominal examination
  • Genitourinary examination
  • PR examination
  • Neurological examination
29
Q

What may be found on abdominal examination in AUR?

A

Tender and enlarged bladder with dullness to percussion well above pubic symphysis, often almost to level of umbilicus

30
Q

What should be looked for in men on genitourinary examination in AUR?

A
  • Phismosis or meatal stenosis
  • Urethral discharge and genital vesicles
31
Q

What should be looked for on genitourinary examination in women?

A
  • Vulval or vaginal inflammation or infection
  • Cystocele, rectocele, or uterine prolapse
  • Pelvic mass
32
Q

What should be checked for on PR examination in AUR?

A
  • Anal tone
  • Prostatic size
  • Nodules
  • Tenderness
33
Q

What may be excluded on PR examination in AUR?

A

Faecal impaction

34
Q

RWhat should be looked for on neurological examination in AUR?

A
  • Evidence of a prolapsed disc or cord compression by checking lower limb power
  • Check perineal sensation
35
Q

How can you differentiate between acute and chronic urinary retention?

A

AUR is usually painful. CUR tends to be relatively pain free

36
Q

What investigations are done in AUR?

A
  • Urinanalysis
  • MSU
  • Blood tests
  • Imaging studies
37
Q

What should be checked for on urinalysis in AUR?

A
  • Infection
  • Haematuria
  • Proteinuria
  • Glucosuria
38
Q

What blood tests should be in AUR?

A
  • FBC
  • U&E
  • Creatinine
  • eGFR
  • Blood glucose
  • PSA
39
Q

What imaging studies may be done in AUR?

A
  • Ultrasound
  • CT scan
  • MRI/CT brain scan
  • MRI scan of spine
  • Cystoscopy
40
Q

What is the use of ultrasound in AUR?

A
  • Provides a measure of post-void residual urine
  • Looks for hydronephrosis and other structural abnormalities of the renal system
41
Q

What is the use of CT scan in AUR?

A

Used to look for pelvic, abdominal, or retroperitoneal mass causing extrinsic bladder neck compression

42
Q

What is the use of MRI/CT brain scan in AUR?

A

Looks for intracranial lesions

43
Q

What is the purpose of MRI scan of spine in AUR?

A

Looks for disc prolapse, cauda equina syndrome, spinal cord compression, or MS

44
Q

How is AUR managed?

A

Immediate and complete bladder decompression wiht immediate catheteristation

45
Q

What medication should be offered before removal of catheter in AUR?

A

An alpha-blocker

46
Q

What does secondary management of AUR involve?

A

Treatment of underlying cause

47
Q

What are the complications of AUR?

A
  • UTIs
  • AKIs
  • Post-obstructive diuresis
  • Post-retention haematuria

A - MSRA Renal and Urinary [17] (17 decks)

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