S10C95 - Acute Urinary Retention Flashcards
DDx of urinary retention
- obstructive (urethral stricture, calculi, neoplasm, FB, BPH, PrCa, phimosis, paraphimosis, meatal stenosis, urthral strangulation, cystocele in women, ovarian/uterine tumor)
- infectious (cystitis, HSV, herpes zoster, abscess. prostatitis, PID)
- pharmacologic
- traumatic (damage to urethra, bladder, SC)
- neurogenic (MS, PD, shy-drager syndrome, tumor, cerebrovascular dz, cauda equina, mets in SC, disk herniation, DM, neuropathy, postop retention, nerve damage from surgery)
- psychogenic (psychosexual stress, acute anxiety)
- childhood (posterior urethral valves, rhabdomyosarcoma, urethral atresia)
- extraurinary causes (abscess, rectal mass, fecal impaction, AAA)
Rx causes of urinary retention:
Alpha adrenergics:
- ephedrine
- phenylephrine
- pseudoephedrine
Beta-adrenergics
- terbutaline
- isoproterenol
Antidepressants: impramine, nortriptyline, amitriptyline, amoxapine, SSRI
Antiarrhythmics:
- flecainide
- quinidine
- procainamide
- disopyramide
Anticholinergics/antispasmodics
-atropine, scopolamine, hyoscyamine, glycopyrrolate, bromide, oxybutynin, tolterodine
Operative: anaesthetic agents
Antiparkinsonian agents: benztropine, amantadine, levodopa, bromocriptine
Hormonal Agents: progesterone, estrogen, testosterone
Antipsychotics:
-haldol, chlorpromazine, prochlorperazine, clozapine, risperidone, ziprasidone
Antihistamines: diphenhydramine, chlorpheniramine, cyproheptadine, hydroxyzine
Antihypertensives: CCB, hydralazine, trimthaphan
Analgesics: opiates, NSAIDs
Muscle relaxants: benzos, baclofen, cyclobenzaprine
Miscellaneous: indomethacine, carbamazepine, amphetamines, dopamine, vincrsitine, ecstasy
Urinary retention: Tx
- catheterization
- first try with 14F-18F foley catheter
- then try with a firmer coude catheter, tip pointing anteriorly
- suprapubic catheterization: sterile prep, use u/s guided approach, advance 22g spinal needle with 10ml syringe posteriorly and caudally at 30 deg angle from true vertical and 60deg from horizontal plane of abdomen, 3-4cm above pubic symphysis in the midline, advance needle while drawing back, then take needle out and putu obturator in the same plane and depth, place cystostomy catheter
- bladder should be 2cm wide in 2 planes for suprapubic catheter insertion
Urinary retention: disposition
- if caused by a significant underlying illness or precipitating factor then admit with uro consult (malignancy, SC compression, hematuria, UTI w sepsis)
- if precipitated by stricture, urethral injury prostatitis, post-op complication or suspected carcinoma –> uro consult
- if spontaneous AUR from BPH related –> leg-bag foley, alpha adrenergic blocker, f/u with uro in 3-7d (consider PSA, 5 alpha-reductase inhibitor)
- providing no bleeding, infection or renal impairment
