Urinary Retention Flashcards
What is Acute Urinary Retention?
When a person suddenly (hours) becomes unable to voluntarily pass urine - the commonest urological emergency.
Epidemiology of Acute Urinary Retention.
Commoner in men (especially above 60).
Aetiology of Acute Urinary Retention.
- BPH (commonest).
- Urethral Strictures.
- Calculi.
- Cystocoele.
- Constipation.
- Masses.
- Medications e.g. Anticholinergics, TCAs, Antihistamines, Opioids, Benzodiazepines.
Clinical Presentation of Acute Urinary Retention (4)
- Inability to Pass Urine.
- Lower Abdominal Discomfort.
- Considerable Pain/Distress.
- Acute Confusional State.
Examination Findings of Acute Urinary Retention (2).
- Palpable Distended Bladder.
2. Lower Abdominal Tenderness.
Investigation of Acute Urinary Retention.
US - Volume More than 300cc.
Management of Acute Urinary Retention.
Decompress Bladder via Catheterisation.
How can the management be used to investigate Acute Urinary Retention?
- A volume less than 200cc drained in 15 minutes = no urinary retention acutely.
- A volume greater than 400cc drained in 15 minutes = catheter should be left in place.
Complication of Acute Urinary Retention.
Post-Obstructive Diuresis - loss of medullary concentration-gradient means kidneys increase diuresis so time is taken to re-equilibrate, leading to volume depletion and worsening of any AKI.
Clinical Presentation of Chronic Urinary Retention.
Painless and insidious.
Clinical Presentation of Acute on Chronic Urinary Retention.
Overflow Incontinence.
High-Pressure Retention vs. Low-Pressure Retention.
High-Pressure : Impaired Renal Function and Bilateral Hydronephrosis (due to BOO)
Low-Pressure : Normal Renal Function and No Hydronephrosis.
What can occur commonly after catheterisation for chronic urinary retention?
Decompression haematuria - rapid decrease in intravesical pressure.
