Urinary Retention Flashcards
What can cause urinary retention?
Urethral blockage
Medications: antimuscarinic, sympathomimetics, tricyclic antidepressants.
What are the types of urinary retention?
Acute: medical emergency - abrupt development over a period of hours
Chronic: gradual over months - inability to completely empty bladder
WHats the most common type of urinary retention in men?
benign prostate hyperplasia
What are the symptoms of benign prostate hyperplasia?
urinary retention, urgency, frequency and nocturia.
How do we treat acute urinary retention?
Immediate catheterisation due to the pain
Provide an alpha blocker for 2+ days before removing catheter
e.g. alfuzosin, doxazosin, tamsulosin, terazosin.
How do we treat chronic urinary retention?
Catheters used long term - may cause recurrent UTI’s, urethra trauma, pain and stone formation.
Men with moderate to severe urinary retention should be offered an alpha blocker
When should the treatment be reviewed for chronic urinary retention?
4 to 6 weeks then every 6 to 12 months
How do we treat benign prostatic hyperplasia
alpha blocker relaxes smooth muscle
Patients with enlarged prostate, raised prostate antigens or at high risk of progression can be given a 5-alpha reductase inhibitor (finasteride or dutasteride)
When should you avoid alpha blockers?
If a patient has a history of micturition syncope (fainting whilst urinating) as it lowers the BP
Patients with postural hypotension
What are side effects with 5-alpha reductase inhibitors (finasteride, dutasteride)
Breast disorder
Sexual dysfunction
Male breast cancer reported - report lumps, pain or nipple discharge
Excreted in semen so use condom if partner is pregnant or likely to become pregnant
what are the MHRA warnings associated with dutasteride and finasteride
Can cause genital malformations and so women of child bearing age should nit handle them.
Can cause depression and suicidal thoughts- stop treatment immediately and inform HCP
