Acute Urinary Retention

Question 1

EPIDEMIOLOGY: AUR

Answer 1

• 10x more common in men than women
• Peak incidence men >70 yrs

Question 2

AETIOLOGY: AUR

Answer 2

1. Obstructive

• BPH
• Urethral stricture
• Stones
• Clot retention post-surgery
• Pelvic mass

2. Inflammatory

• UTI
• Prostatitis

3. Drugs

• Alcohol
• Diuretics
• Opioids

4. Neurogenic

• Spinal cord injury
• MS/PD
• Pelvis surgery
• Epidural/spinal anaesthesia

Question 3

CLINICAL FEATURES: AUR

Answer 3

Symptoms

• Lower abdo pain
• Unable to pass urine

Signs

• Suprapubic tenderness
• Palpable bladder (dull percussion/unable to get beneath it)
• Large prostate on DRE

Question 4

RED FLAGS: AUR

Answer 4

• Weight loss
• Bone Pain
• Cauda Equina syndrome
• Haematuria

Question 5

INVESTIGATIONS: AUR

Answer 5

1. Cultures
   * Dipstick & MC&S (infection)
2. Bloods
   * FBC, U&Es, (PSA if chronic)
3. Imaging
   * Ultrasound KUB (bladder volume & hydronephrosis)

Question 6

MANAGEMENT: AUR

Answer 6

• 1. Conservative*
• Analgesia, encourage patient privacy, movement and emptying of bowels
• 2. Medical*
• Tamsulosin may reduce risk of catheterisation after retention.
• Laxatives (constipation suspected)
• Antibiotics (infection suspected)

3. Surgical

• Catheter +/- antibiotic cover.
• TWOC after 2-3 days.