Chronic Urinary Retention

Question 1

What is chronic urinary retention

Answer 1

Painless inability to pass urine

There is long standing retention and significant bladder distension leading to bladder desensititation

Question 2

Comm on cause in men

Answer 2

BPH most common

Urethral strictures or prostate cancer

Question 3

What can cause it in women?

Answer 3

Pelvic prolapse like cystocele, rectocele or uterine prolapse

Pelvic masses can cause chronic retention

Question 4

Neurological causes

Answer 4

Peripheral neuropathies

Parkinsons

MS

Question 5

Clinical features

Answer 5

Painless urinary retention

Associated voiding luts like weak stream and hesitancy

Overflow incontinence might be present

Intra-vesical pressures rise greater than those of the urinary sphincter

Nocturnal enuresis

Question 6

Examination findings

Answer 6

Palpable distended bladder with no or minimal tenderness

Do DRE as well in men

Question 7

Investigations

Answer 7

Post-void bedside bladder scan

Routine bloods with FBC, CRP and U&Es

Highpressure retention warrants US-KUB

Question 8

Management >1L or evidence of high pressure retention

Answer 8

Catheterised with a long-term catheter

Urine output needs bo monitored as well for post-obstructive diuresis

Question 9

When should TWOC be done?

Answer 9

It shouldn’t be done.

Due to risk of repeat renal injury they should have long-term catheter before definitve management

Alternatives to this include ISC or suprapubic catherisation

Question 10

Definitive management of chronic retention

Answer 10

Depends on underlying cause

Question 11

Long term management without long-term catheter

Answer 11

Intermittent self catheterisation

Patients are taught how to do it themselves at regular intervals every 4-6hrs

Question 12

Complications

Answer 12

UTI

Bladder calculi

CKD