Urinary Retention

Question 1

Causes of urinary retention:

Answer 1

URETERIC
- Renal stone
- Stricture
- Tumour
- Clot
- External compression (eg. prolapse, constipation)

BLADDER
- Neurogenic bladder (diabetes, SCI, Parkinson’s, MS)
- Detrusor dyssynergy
- Medications:
–> Anticholinergics
–> Opioids, BZDs
–> Oxybutinin
- Bladder stones
- Clot retention
- UTI with sediment
- Trauma

PROSTATIC
- BPH
- Ca

URETHRAL/ PENILE
- Trauma
- Stricture etc.
- Phimosis
- Priapism

OTHER
- Psychogenic/ functional
- Painful GU condition (eg. Herpes)

Question 2

Work up of urinary retention:

Answer 2

HISTORY
- Meds incl. anticholinergics
- Symptoms of: UTI, Ca, spinal
- Neurogenic (MS, Parks, diabetes)
- Haematuria
- Cancer Sx
- Genital symptoms

EXAMINATION
- Bladder
- Neurological
- Antichol syndrome

BLADDER SCAN

–> Insert IDC (or SPC if unable)
If more 1L out, consider chronic retention and monitoring for post-obstructive diuresis

Send urine for dipstick, MCS, cytology.

BLOODS:
- FBC, CRP
- PSA
- AKI

IMAGING:
Guided by suspected cause
- USS, CT KUB, CTAP, IV pyelogram, retrograde pyelogram, micturing cystourethrogram, cystoscopy…..

Question 3

What bladder volumes are considered ‘retention’?

Answer 3

Full retention = Typically 500 plus, but no strict criteria. uncomfortable, desire to void and unable

Incomplete retention = Post void > 50ml (100ml elderly) (10% capacity in kids)

Question 4

Post-obstructive diuresis:

Answer 4

Usually after relief of retention >1000-1500ml
- >200ml/hr for 2+ hours
- >3L in 24/24

Risks:
- Low: Na, K, PO4, Mg
- Hypovol

Replace at 80% volume lost

Question 5

Management of retention secondary to clot:

Answer 5

• 22French 3-way catheter
• 0.9% saline irrigation (free running)
• Manual 50ml flush/suck if blocked
• Monitor Na
• Cystoscopy +-

Question 6

IDC types:

Answer 6

Foley
- 6 - 26F
- Adults 12 - 14F
- Paeds:
–> 2x ETT (age 4+4)
–> Same as NGT

Coude-tip
–> Feeding past prostate, stricture

Whistle-tip
–> Open-tip, for debris

22F 3 way
–> Washout

Question 7

Insertion of IDC:

Answer 7

Change 4-6 weekly

Question 8

Insertion of SPC:

Answer 8

Change 4-6 weekly
Tract closes very quickly
Don’t play in ED unless tract at least 2 weeks old

Preloaded trochar, or trochar that you feed SPC into

• 2 finger breadths above pubic symphysis, just off midline
• Local
• Incise with scalpel
• Insert trochar/catheter perpendicular, in quick ‘stab’ motion until urine flows
• Once urine flowing, move quickly (bladder will shrink away as it decompresses)
• Inflate
• Remove trochar
• Attach bag
  -Silk stitch

First change 6 weeks