FN: Urinary Retention

Question 1

Causes

Answer 1

Obstructive
Neurological
Myogenic

Question 2

Obstructive causes

Answer 2

Mechanical

Dynamic

Question 3

Mechanical

Answer 3

BPH
Urethral stricture
Clots, stones
Constipation

Question 4

Dynamic

Answer 4

Increased smooth muscle tone (alpha-adrenergic)
- post operative pain
Drugs

Question 5

Neurological

Answer 5

Interruption of sensory or motor innervation

• pelvic surgery
• MS
• DM
• Spinal injry/compression

Question 6

Myogenic

Answer 6

Over-distension of the bldder

• post anaesthesia
• high EtOH intake

Question 7

Acute urinary retention (AUR) clinical features

Answer 7

Suprapubic tenderness
Palpable bladder
- dull to percussion
- Cant get beneath it

Large prostate on PR - check anal tone and sacral sensation

Question 8

Investigations

Answer 8

Blood: FBC, U+E, PSa (prior to PR)
Urine: dip, MC+S
Imaging:
- Us: bladder volume , hydronephrosis
- Pelvic XR

Question 9

Mx conservative

Answer 9

analgesia
Privacy
Walking running water or hot bath

Question 10

Catheterise

Answer 10

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

Question 11

Medical Mx alongside Cather

Answer 11

Tamsulosin: reduces risk of recatheterisation after retention

Question 12

TURP

Answer 12

Failed TWOC
Impaired renal function
Elective

Question 13

Chronic Urinary retention classification

Answer 13

high pressure

Low pressure

Question 14

high pressure

Answer 14

• high detrusor pressure @ end of micturition
  Typically bladder outflow obstruction
• bilateral hydronephrosis and reduced renal function

Question 15

Low pressure

Answer 15

Low detrusor pressure @ end of micturition
LArge volume retention with very compliant bladder
Kidney able to excrete urine
No hydronephrosis therefore normal renal function

Question 16

Presentation

Answer 16

Insidious as bladder capacity increased (>1.5 L)
Typically painless
Overflow incontinence/nocturnal enuresis
Acute on chronic retention
Lower abdo mass
UTI
Renal failure

Question 17

Ma high pressure

Answer 17

Catheterise if

• renal impairement
• pain
• infection

Hrly U + replace: post-obstruction diuresis
Sonsider TURP before TWOC

Question 18

Low Pressure Mx

Answer 18

Avoid catheterisation if possible - risk of introducing infection

Early TURP

• often do poorly due to poor detrusor function
• need CSIC or permanent catheter

Question 19

Suprapubic Catheter advantages

Answer 19

reduces UTIs
Reduces stricture formation
TWOC w/o catheter removal
Pt . preference: increased comfort
Maintain sexual function

Question 20

Suprapubic Catheter disadvantages

Answer 20

More complex: need skills

Serious complications can occur

Question 21

Suprapubic Catheter CI

Answer 21

• known or suspected bladder carcinoma
• Undiagnosed haematuria
• Previous lower abdominal surgery - adhesion of small bowel to abdo wal

Question 22

Clean intermittant self catheterisation

Answer 22

Alternative to indwelling catheter in AUR and CUR

Also useful in pts. who fail to void after TURP