Acute + Chronic Urinary Retention Flashcards
What is acute urinary retention?
New onset inaility to pass urine (or very small quantities) which leads to pain and discomfort, with significant residual volumes
Who is acute urinary retention most prevelant in and why?
Older males due to enlarged prostate causing bladder outflow obstruction
What is acute-on-chronic retention?
Patients in chronic retention can enter acute retention, either due to acute deterioration of underlying pathology or new aetiology.
How do acute-on-chronic patients present?
Minimal discomfort and much higher residual volumes then just acute retention
What are the causes of acute urinary retention?
BPH - most common
UTI - especially in BPH
Constipation - compression on urethra
Severe pain
Medications - anti-muscarinics or spinal or epidural anaesthesia
Neurological - peripheral neuropathy, iatrogenic - pelvic surgery, upper motor neurone disease, bladder sphincter dysinergy
What are the clinical features of acute urinary retention?
Acute suprapubic pain and inability to micturate
Palpable distended bladder with suprapubic tenderness. May have fevers/rigors or lethargy
PR exam - enlargered prostate or constipation
What investigations should be requested for in acute urinary retention?
Routine bloods
Post-cauterisation, a CSU (catheterised specimen of urine)
Post-void bedside bladder scan - volume of urine retained
In high-pressure retention - ultrasound scan - look for hydronephrosis
What is high-pressure urinary retention?
Urinary retention causing such high intra-vaesicular pressures that anti-reflux mechanism of the bladder and ureter is overcome and backs up into upper renal tract leading to hydrureter and hydronephroisis.
What is the management of acute urinary retention?
Immediate urethral catheterisation - measure the volume drained post-catheterisation
Treat underlying cause - BPH - tamsulosin
Infection - antibiotics
Review medication
What is post-obstrctive diuresis and how should it be managed?
Folowing resoluton of retention, kidneys can often over-diurese and lead to worsening AKI. Pts at risk are large retention volume (acute-on-chronic).
Should be monitored for 24 hours post catherterisation and if producing >200ml/hr, should have 50% of urine ouput replaced by IV fluids.
What is the management in high-pressure retention?
Keep catheters in-situ until definitive management can be arranged (e.g.TURP) due to futher risk oof episodes of urinary retention causing AKI.
When is trial without catheter used and what is it?
Used if no evidence of renal impairment.
Catheter removed 24-48 hrs after insertion. If pt voids successfully with minimal residual volume the successful. If not then re-catherisation will be required.
Further TWOCS can be attempted but mulpitle failed events will warrent long-term catheter, until definitive managment for underlying cause.
What are the complications of acute urinary retention?
AKI and chronic kidney injury as multiple episodes can lead to reanl scarring.
UTI and renal stones
What is chronic urinary retention?
Painless inability to pass urine. Long standing retention with significant bladder distension which results in bladder desensitisation therefore minimal discomfort despite potential large intra-vesical volumes.
What are th causes of chronic urinary retention?
BPH
Urethral strictures
Prostate cancer
Women - pelvic prolapese or pelvic masses (large fibroids)
Neurological causes - peripheral neuropathies, upper motor neurone disease (MS, parkinsons)
What are the clinical features of chronic urinary retention?
Painless urinary retention
May have associated voidng LUTS
Overflow incontinence may be present especially at night - nocturnal enuresis
Palpable distended bladder
PR exam - prostate enlargement
What are the investigations for chronic urinary retention?
Routine bloods
Post-void bedside bladder scan
High pressure - ultrasound scan
What is the management for chronic urinary retention?
Long-term Catheterisation - if high volume >1L or high pressure retention, monitor urine output
Don’t do TWOC - should have long term catheter or intermittent self catheterisation or suprapubic catheterisation
When is intermittent self catheterisation used in chronic urinary retention?
Pts who sih to avoid long term catheter
Requires good manual dexterity and pateint compliance. Change ate regular intervals (every 4-6 hrs)
What are the complications of chronic urinary retention?
UTI
Bladder calculi
CKD
