Urinary Retention

Question 1

What is acute urinary retention?

How is this managed immediately?

Answer 1

Acute and painful inability to pass urine
Relieved by insertion of a catheter

Insertion of catheter

Question 2

What is chronic urinary retention?

Answer 2

Bladder stretching and adapting overtime to distal obstruction leading to large residual volume i.e. >800ml

Question 3

How is someone likely to present with urinary retention?

Answer 3

Pain 
Discomfort 
Anuria 
Distended and tender bladder 
More likely to be older males

Question 4

What are the 4 main causes of urinary retention?

What conditions will come under this causes?

Answer 4

Inflammatory

• UTI
• Prostatitis

Obstructive

• BPH/E
• strictures
• bladder neck stenosis
• constipation
• pelvic mass
• clot retention
• prolapse
• bladder cancer (obstructing neck of bladder)

Neurogenic

• cauda equina syndrome (CES)
• SC injury
• MS
• PD
• Pelvic injury
• pelvic surgery

Drugs

• alcohol
• anticholinergics
• diuretics
• spinal anaesthesia
• opiods

Question 5

What are the red flags symptoms for someone presenting with urinary retention?

Answer 5

For cauda equina:

• lower back pain
• LL neurology
• saddle anaesthesia
• decreased anal tone on DRE

For malignancy

• weight loss
• bone pain
• haematuria

For high pressure chronic retention (HPCR)
-nocturnal bed wetting due to overflow incontinence

Question 6

What investigations should be done for someone experiencing urinary retention?

Answer 6

Urinalysis
-infection/haematuria/proteins

MSU

FBC- infection
U+E- renal function
Glucose
PSA

USS 
-measure post-voiding residual volume 
-look for hydronephrosis 
CT scan 
-looking for extrinsic causes of neck of bladder compression 

MRI of spine

Cystoscopy etc

Question 7

What is the management for urinary retention?

Answer 7

Catheterisation to decompress the bladder

Monitor hrly UO

Question 8

What can occur as complication of HPCR when patient catheterised? How is this managed?

Answer 8

Can lead to post-obstructive diuresis due to renal tubule dysfunction and inappropriate handling of salt
I.e. leads to patient becoming rapily dehydraed and hyponatraemic

Mx:

• normal saline IV
• leave catheter in