chronic urinary retention Flashcards
Define chronic urinary retention
Painless, palpable and percussible bladder after voiding’
What causes chronic urinary retention
Detrusor under activity
What is Detrusor under activity
Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span.
How does chronic urinary retention present
Presents as LUTS or complications (e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure) or incidental finding
Can patients with chronic urinary retention void?
Yes
What size can the residual volumes be in chronic urinary retention
The residuals ranging from 400ml to >2 litres depending on stage of condition (i.e. wide spectrum)
What is treatment for chronic urinary retention
Asymptomatic patients with low residuals do not necessarily need treatment
Patients with symptoms or complications need treatment (but no role for medical therapy!)
Immediate treatment is catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)
What are the complications of chronic urinary retention
UTI
Post-decompression haematuria (normally happens and doesn’t need to be investigated),
Pathological diuresis:
Electrolyte abnormalities (hyponatraemia, hyperkalaemia, metabolic acidosis)
Persistent renal dysfunction due to acute tubular necrosis
What is pathological diuresis
Urine output >200ml/hr + postural hypotension (systolic differential >20mm Hg between lying and standing) + weight loss + electrolyte abnormalities
Is TURP used in chronic urinary retention
TURP in chronic retention has a less successful outcome than for acute retention; however, patients with high pressure chronic retention has better outcome with TURP than patients with low pressure chronic retention
