FN: Urinary Retention Flashcards
Causes
Obstructive
Neurological
Myogenic
Obstructive causes
Mechanical
Dynamic
Mechanical
BPH
Urethral stricture
Clots, stones
Constipation
Dynamic
Increased smooth muscle tone (alpha-adrenergic)
- post operative pain
Drugs
Neurological
Interruption of sensory or motor innervation
- pelvic surgery
- MS
- DM
- Spinal injry/compression
Myogenic
Over-distension of the bldder
- post anaesthesia
- high EtOH intake
Acute urinary retention (AUR) clinical features
Suprapubic tenderness
Palpable bladder
- dull to percussion
- Cant get beneath it
Large prostate on PR - check anal tone and sacral sensation
Investigations
Blood: FBC, U+E, PSa (prior to PR) Urine: dip, MC+S Imaging: - Us: bladder volume , hydronephrosis - Pelvic XR
Mx conservative
analgesia
Privacy
Walking running water or hot bath
Catheterise
Use correct catheter e.g. 3- way if clots
± stat gen cover
Hrly UO + replace: post-obstruction diuresis
TWOC after 24-72 h
- may d/c and f/up in OPD
more likely to be successful if predisposing factor and lower residual volume
Medical Mx alongside Cather
Tamsulosin: reduces risk of recatheterisation after retention
TURP
Failed TWOC
Impaired renal function
Elective
Chronic Urinary retention classification
high pressure
Low pressure
high pressure
- high detrusor pressure @ end of micturition
Typically bladder outflow obstruction - bilateral hydronephrosis and reduced renal function
Low pressure
Low detrusor pressure @ end of micturition
LArge volume retention with very compliant bladder
Kidney able to excrete urine
No hydronephrosis therefore normal renal function
Presentation
Insidious as bladder capacity increased (>1.5 L) Typically painless Overflow incontinence/nocturnal enuresis Acute on chronic retention Lower abdo mass UTI Renal failure
Ma high pressure
Catheterise if
- renal impairement
- pain
- infection
Hrly U + replace: post-obstruction diuresis
Sonsider TURP before TWOC
Low Pressure Mx
Avoid catheterisation if possible - risk of introducing infection
Early TURP
- often do poorly due to poor detrusor function
- need CSIC or permanent catheter
Suprapubic Catheter advantages
reduces UTIs Reduces stricture formation TWOC w/o catheter removal Pt . preference: increased comfort Maintain sexual function
Suprapubic Catheter disadvantages
More complex: need skills
Serious complications can occur
Suprapubic Catheter CI
- known or suspected bladder carcinoma
- Undiagnosed haematuria
- Previous lower abdominal surgery - adhesion of small bowel to abdo wal
Clean intermittant self catheterisation
Alternative to indwelling catheter in AUR and CUR
Also useful in pts. who fail to void after TURP
