Disorders and conditions affecting the bladder and elimination of urine:

Question 1

Common disorders and conditions:

Answer 1

• Vesico-ureteric reflux:
• abnormal backflow of urine from the bladder to the ureter/s
• S&S - may not be obvious until infection develops or when kidney damage has occurred
• Polycystic kidney disease:
• enlarged kidneys caused by fluid filled cysts
• S&S - hypertension, haematuria and low back pain
• Hypospadias:
• abnormality or malformation of the penis
• S&S - urethra is not at the end of penis affecting urine flow
• Neoplasms:
• cancer of kidney, bladder and cancer of prostate
• S&S - haematuria, urinary obstruction
• Cystitis:
• inflammation of the bladder
• Urethritis:
• inflammation of the urethra
• S&S for both - pain in kidney region, n&v, fatigue, rigors, dysuria, cloudy and blood-stained offensive urine

Question 2

Urinary elimination:

Answer 2

• normal capacity of the bladder is approx. 450ml, with individual capacity ranging from up to 600-1000ml
• at approx. 450ml, stretch receptors in the bladder wall initiate an impulse to the brain via the spinal cord

Question 3

Alternation in urinary elimination:

Answer 3

• may be temporary or long term
• urine output may increase during diuresis treatment and the diuretic phase of renal failure
• causes of decreased urine output include pre renal causes such as dehydration, hypotension related to shock and post-operatively

Question 4

Urinary retention:

Answer 4

• is the inability to fully empty the bladder after voiding or a complete inability to pass urine
• can be acute or chronic
• Causes:
• benign enlargement of the prostate glands in male
• postoperative complications
• epidural anesthetic or infusion
• medications
• after removal of an indwelling catheter
• poorly controlled pain
• after vaginal birth

Question 5

S&S of acute urinary retention:

Answer 5

• bladder distension
• residual urine on bladder scan (up to 2000-3000ml)
• absence of urine output over several hours
• discomfort, restlessness and diaphoresis (sweating)

Question 6

Urinary catheters:

Answer 6

• can be inserted via the urethra or less commonly through an incision in the supra-pubic region
• can be inserted to empty the bladder and then removed immediately, or it may be left in the bladder
• indwelling catheters are usually self-retaining with a small inflatable balloon which sits at the neck of the bladder to prevent the catheter falling out

Question 7

Chronic retention:

Answer 7

• results from incomplete bladder emptying over a period of time
• Causes:
• partial obstruction of the urethra
• reduced ability of the bladder muscle to contract during voiding
• S&S:
• retention with overflow may develop
• urge to void but is only able to void small amounts
• constant dribbling of urine
• incomplete bladder emptying
• Complications:
• damage to kidneys
• UTIs

Question 8

Contraindications for catheterisation:

Answer 8

• urethral stricture, trauma or reconstruction surgery
• urethral orifice cannot be identified or accessed due to injury, obstruction or urogenital atrophy
• a suprapubic catheter is an alternative in these situations

Question 9

Monitoring an IDC:

Answer 9

• Check:
• drainage bag for emptying
• tube is patent and draining continuously
• IDC and tubing are securely connected
• drainage bag is supported on a stand or hook that avoids loops in the tubing to keep system off the floor
• drainage bag is always below the level of the bladder including during movement
• catheter remains secured to the patient with a securing device

Question 9

Intermittent catheterisation:

Answer 9

• a short, semi-rigid catheter is inserted and removed immediatley after emptying the bladder
• purpose - relieve retention, obtain a specimen, check for post void residual
• often referred to as an “in-out catheter”

Question 10

Bladder irrigation:

Answer 10

• routinely used following TURP (trans urethral retrograde prostatectomy) to prevent large clot formation and obstruction of catheter
• irrigation is suspended above patient and run via tubing with a roller clamp to adjust flow rate

Question 11

Bladder washout:

Answer 11

• is required if the catheter becomes occluded, usually with clots following TURP
• S&S - urine or continuous bladder irrigation has stopped draining, distended bladder, patient complains of pain or discomfort