Acute urinary retention

Question 1

What is acute urinary retention?

Answer 1

Suddenly unable to voluntarily pass urine

Question 2

What are causes of acute urinary retention?

Answer 2

Benign prostatic hyperplasia
Urethral strictures
Urethral calculi
Cystocele
Constipation
Masses
Anticholinergics
Tricyclic antidepressants
Antihistamines
Opioids
Benzodiazepines
Neurological

Question 3

What are CF of acute urinary retention?

Answer 3

Inability to pass urine
Lower abdominal discomfort
Considerable pain or distress

Overflow incontinence with background of chronic urinary retention (which is painless)

Question 4

What are signs of acute urinary retention?

Answer 4

Palpable distended urinary bladder on abdoinal or rectal exam
Dullness to percussion up to umbilicus - 1000ml

Question 5

What Ix in acute urinary retention?

Answer 5

MSU for MC&S - might only be possible after catheterisation
U&E - AKI?
FBC/CRP for infection

Bladder US - volume of over 300c confims diagnosis

Question 6

Mx in urinary retention?

Answer 6

Decompress the bladder via catheterisation

Volume drained in 15 minutes
Volume of <200 confirms patient does not have acute urianry retention
Volume over 400cc means catheter should be left in place

Investigate and treat cause