Lesson 9: Urinary Retention Flashcards
Pathology
- Inability to empty bladder effectively
- Causes frequency, urgency, and low voided volumes
- Can cause secondary urge incontinence d/t rapid refilling
Acute Retention
- Sudden inability to pass urine
- Acutely painful
- Usually d/t surgery, meds, constipation, or spontaneous
Chronic Retention
- Incomplete bladder emptying
- Abnormally high PVRs (>300 mLs)
- Non-painful
High pressure chronic retention (HPCR)
- Usually causes by bladder outlet obstruction
- Detrusor pressure rises in attempt to push urine through obstructed outlet
- High risk for renal damage
Low pressure chronic retention (LPCR)
- Usually caused by weak detrusor muscle
- Contractility is impaired
- Low risk for renal damage
- Treatment urgency based on patient’s concerns + issues with UTIs
Etiology
Bladder outlet obstruction
- BPH
- Cystocele
- Pelvic organ prolapse
- Bladder sphincter dyssynergia
Impaired detrusor contractility
- Diabetic neuropathy
- MS
- Sacral spinal cord injury
- Advanced age
Presentation
Acute
- Rapid onset bladder distension
- Total inability to void
- Acutely painful
Chronic
- Frequent low volume urinary with nocturia
- Feelings of incomplete emptying
- Weak or intermittent stream
- Bladder distension +/- suprapubic tenderness
- High PVRs
- Post-void dribbling
Diagnostics
Presumptive diagnosis, based on
- History + physical
- Risk factors
- Feelings of incomplete emptying
- Frequency
- Nocturia
- Suprapubic distention
- Tenderness
- Uroflow = poor + intermittent stream
- Bladder chart = frequency, low voided volumes, nocturia
- PVR = 250-300 mLs
- Urinalysis = positive if associated infection
- Ultrasound = renal hydronephrosis in patients with HPCR
Definitive diagnosis = pressure flow study
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Management - Acute
Urgent catheterization to decompress bladder
Initial volume of >1 L important to differentiate acute vs chronic
Management - Obstruction Lesion
- Surgery or medication for BPH
- Surgery or pessary for cystocele or pelvic organ prolapse
- Manage risk factors
- Trial of void with careful monitoring of PVR volumes
Management - Chronic
Definitive correction of any outlet obstruction
Measures to improve detrusor contractility
- Sacral neuromodulation
— Indicated for nonobstructive retention
- Scheduled voiding/double voiding
- Clean intermittent catheterization
- Indwelling catheter
Management - Clean Intermittent Catheterization
Indications
- Short-term for patients with post-op retention
- Long-term for impaired detrusor contractility
- Used in conjunction with antimuscarinics
Principles
- Eliminate stasis + chronic distension
- Improves blood flow to bladder wall
- Improves bladder health
- Resistance to infection
Criteria
- Sufficient bladder capacity to store 3 hours of urine
- Sufficient mobility + dexterity
- Cognitively intact
- Motivated + committed
- 1.5 - 2L/day
Management - Indwelling Catheter
Urethral or suprapubic
Indications
- High pressure retention
- Bladder outlet obstruction
- Close urinary monitoring
- Terminally ill patient for comfort
- Management of incontinence for pressure injury on trunk
Guidelines
- Remove ASAP
- Use smallest effective catheter
- Maintain closed system
- Change long-term Q4-6 weeks
Complications
- CAUTI
- Bypassing
- Encrustation
Management - Suprapubic Catheter
- Inserted in IR
- Good long-term option
- Reduced risk of medical device-related pressure injury
