Retention

Question 1

does acute or chronic urinary retention have a higher volume?

Answer 1

chronic >1.5 litres

acute <1 litre

Question 2

what is a very serious condition to rule out with acute urinary retention and how do you rule it out?

Answer 2

cauda equina syndrome

check anal tone and sacral sensation with a whole spine MRI

Question 3

what investigations should be done for acute urinary rention?

Answer 3

FBC, U&Es, PSA
urinalysis, MCS
US
pelvic XR

Question 4

what is the management for acute urinary retention?

Answer 4

analgesia

catheterise
hourly urine output checks and replace any losses to prevent post obstructive diuresis
tamsulosin
trial without catheter

TURP
- if failed TWOC or impaired renal function

Question 5

what are the two classifications of chronic urinary retention??

Answer 5

high pressure

low pressure

Question 6

what causes high pressure chronic urinary retention?

Answer 6

High detrusor pressure @ end of micturition
 Typically bladder outflow obstruction
 → bilateral hydronephrosis and ↓ renal function

Question 7

what causes low pressure chronic urinary retention?

Answer 7

Low detrusor pressure @ end of micturition
 Large volume retention c¯ very compliant bladder
 Kidney able to excrete urine
 No hydronephrosis  normal renal function

Question 8

what is the management of high pressure chronic urinary retention?

Answer 8

same as acute urinary retention

 Catheterise if
 Renal impairment
 Pain
 Infection
 Hrly UO + replace: post-obstruction diuresis
 Consider TURP before TWOC

Question 9

what is the management of low pressure chronic urinary retention?

Answer 9

Avoid catheterisation if possible
 Risk of introducing infection
 Early TURP
 Often do poorly due to poor detrusor function
 Need CISC or permanent catheter

Question 10

state some advantages of suprapubic catheterisation?

Answer 10

 ↓ UTIs
 ↓ stricture formation
 TWOC w/o catheter removal
 Pt. preference: ↑ comfort
 Maintain sexual function