Acute urinary retention Flashcards

1
Q

What is acute urinary retention?

A

new onset inability to pass urine which leads to pain, discomfort and significant residual volume

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2
Q

What is acute n chronic retention?

A

Patients with chronic retention can also enter acute retention due to deterioration, may have higher residual volumes than acute

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3
Q

What is the most common cause of acute urinary retention?

A

BPH

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4
Q

What else can cause acute urinary retention?

A

urethral strictures, prostate cancer, UTIs, constipation, severe pain, anti- muscarinic s, spinal anaethesia, peripheral neuropathy, iatrogenic nerve damage, upper motor neurone disease, bladder sphincter dysinergy

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5
Q

What is bladder sphincter dysinergy?

A

lack of coordination of detrusor muscle contraction with urethral sphincter relaxation leading to contraction against a closed sphincter, often seen in spinal cord pathology or traumatic injury

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6
Q

what are the clinical features of acute urinary retention?

A

acute suprapubic pain and an inability to micturate with symptoms suggesting the cause,
will have a palpable distended bladder, suprapubic tenderness, if have fever and riggers, lethargy may be signs on infective cause
PR should be preformed to check for prostate enlargement and constipation

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7
Q

What investigations should be done for acute urinary retention?

A

Post void bedside bladder scan
Routine bloods- FBC, CRP and U&E
After inserting a catheter should do a catheterised specimen of urine
ultrasound to check for hydronephrosis is high pressure

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8
Q

What is high pressure urinary retention?

A

Urinary retention causing high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and backs up into the upper renal tract causing hydrometer and hydronephorisis so impairs the kidneys clearance

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9
Q

How does high pressure urinary retention present?

A

deranged renal function, hydronephorosis in imaging

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10
Q

What can repeat episodes of high pressure retention cause?

A

renal scarring and chronic kidney disease

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11
Q

What is the management for acute urinary retention?

A

immediate urethral catheterisation and measure the volume, causes treated

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12
Q

What is post obstructive diuresis?

A

the kidneys may over-diurese due to loss of their medullary concentration gradient during catheterisation, this can lead to an AKI

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13
Q

If you have high pressure urinary retention then when can the catheter be removed?

A

Not until the definitive management is arranged e.g. TURP

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14
Q

What is a TWOC?

A

Trial without catheter

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15
Q

What are the complications of acute urinary retention?

A

Acute kidney injury, chronic kidney injury, scarring, UTIs and renal stones

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