Acute and Chronic Urinary Retention Flashcards
What is acute urinary retention?
When a person is suddenly (over a period of hours or less) unable to voluntarily pass urine. It is the most common urological emergency.
What is the epidemiology of acute urinary retention?
13:1 Men:Women
Men > 60 (incidence increases with age)
1/3 men over 80
What are the causes of acute urinary retention?
Benign prostatic hyperplasia
Urethral obstructions (strictures, calculi, cystocele, constipation or masses)
Medications (anticholinergics, tricyclic anti-depressants, antihistamines, opioids, benzodiazepines)
Neurological causes
UTI (predisposing factors)
Postoperatively
Women postpartum
What are the symptoms of acute urinary retention?
Inability to pass urine
Lower abdominal discomfort
Considerable pain or distress
How can acute urinary retention present in someone with pre-existing chonic urinary retention?
Overflow incontinence
What are the signs of acute urinary retention?
Palpable distended urinary bladder on abdominal or rectal exam
Lower abdominal tenderness
What are the investigations for acute urinary retention?
Rectal and neurological examinations (Men/Women)
Pelvic examination (Women)
Urinalysis and culture (catheterisation)
Serum U&Es and creatinine (test for kidney injury)
FBC and CRP
(PSA will be raised)
Ultrasound scan of bladder
What is the management of acute urinary retention?
Decompressing the bladder via catheterisation (>300 cc confirms diagnosis)
Investigation and treatment of underlying cause
How does chronic urinary retention present?
Painless and insidious retention a higher volumes of urine
What are the two different types of chronic urinary retention?
High pressure retention
- Impaired renal function and bilateral hydronephrosis
- Typically due to bladdeer outflow obstruction
Low pressure retention
- Normal renal function and no hydronephrosis
What is decompression haematuria?
Presence of blood in the urine
Occurs commonly after catheterisation for chronic retention due to the rapid decrease in the pressure in the bladder.
What is the treatment of chronic haematuria?
Decompression catheterisation
