Acute Urinary Retention

Question 1

20% of people over 60 will have acute urinary retention. Is it more common in males or females?

Answer 1

Males

Question 2

What is the pathophysiology behind anti-cholinergic use in the setting of urinary retention?

Answer 2

Anti-cholinergics => Anti-PNS
=> Reduced detrusor activity
+ Increased sphincter tone

Question 3

Give 2 examples of sympathomimetics

Answer 3

Drugs: Cocaine, amphetamines

ADHD drugs (Methyphenidate, Ritalin)

Question 4

Give 6 non-obstructive causes of acute urinary retention

Answer 4

Question 5

What is the most common cause of urinary retention?

Answer 5

BPH

Question 6

What is phimosis?

Answer 6

Irretractable foreskin

Question 7

You are asked in the long case to give differentials for acute urinary retention. go for it

Answer 7

Question 8

Youre in a long case on acute urinary retention and your examiner asks whether you should order a PSA. What will you say?

Answer 8

It is routine to order a PSA in the case of urinary retention however in the acute setting the PSA will be falsely elevated => not routine in the acute setting

Question 9

What is the typical presentation of a 70 year old man with acute urinary retention

Answer 9

Question 10

In an ideal scenario, what examinations would you like to perform in a long case?

What signs are you looking for in each?

Answer 10

Abdominal exam
DRE
Neuro exam
+/- Pelvic exam

Question 11

A patient presents with acute urinary retention and you suggest inserting a urinary catheter. The examiner is asking you to give 3 reasons as to why?

Answer 11

1) Diagnostic + therapeutic
2) Monitor urinary output
3) Send urine for urinalysis, MC&S

Question 12

What are the components of urodynamic studies. Explain as far as you would like as this is very low yield

Answer 12

Question 13

What investigations would you like to order to investigate urinary retention
Full list + reasoning where applicable

Answer 13

Question 14

There are many many causes of acute urinary retention. How would you approach treating any of these patients regardless of the cause?

Include also the actual treatment and escalations

Answer 14

Revise medications to ensure no cause + ensure no neurological cause from history, exam, and records.
+ perform necessary investigation

1) Urethral catheterisation
2) Intermittent self-catheterisation (OPD/recurrent with dexterity and education)
3) Suprapubic catheter (Inpatient/CI to others)

+ treat cause