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Phase 4 Surgery > Urinary Retention > Flashcards

Urinary Retention Flashcards

1
Q

What are some causes of acute urinary retention?

A
  • Most commonly due to BPH.
  • Others: urethral strictures, calculi, cystocoele, constipation, neurological
  • Drugs: Anticholinergics, tricyclic antidepressants, antihistamines, opioids
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2
Q

Explain the presentation of acute urinary retention

A
  • Inability to pass urine,
  • Lower abdominal discomfort and distention,
  • Considerable pain/distress
  • Acute confusional state
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3
Q

What are the investigations fir acute urinary retention?

A
  • Bladder scan
  • Catheterisation with urine sample sent for urinalysis and culture
  • UEs, FBC and CRP
  • Not PSA as it is likely raised in acute retention anyways
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4
Q

What is the management of acute urinary retention?

A
  • Decompressing the bladder via catheterisation
  • Investigate the cause
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5
Q

What volume of urine indicates urinary rentention?

A

> 300cc. If over 400cc then catheter should remain in place

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6
Q

What are the complications of acute urinary retention?

A
  • Post obstructive diuresis. Occurs as there has been loss of the medullary concentration gradient. This can result in volume depletion so patient may need IV fluids
  • Hyperkalaemia
  • Hydronephrosis
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7
Q

Name some drugs which may cause urinary retention

A
  • Tricyclic antidepressants,
  • anticholinergics
  • Opioids
  • NSAIDs
  • Disopyramide
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8
Q

What is the difference between acute and chronic urinary retention?

A

Chronic has the absence of pain and urge to urinate as it develops over a long period of time. Therefore patients can retain up to 5L

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9
Q

What are the causes of chronic retention?

A
  • BPH most commonly,
  • Prostatic cancer
  • Meds eg, antihistamines, anticholinergics,
  • Congenital conditions such as posterior urethral valves
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10
Q

What are the signs and symptoms of chronic urinary retention?

A
  • Frequency,
  • Hesitancy,
  • Urgency,
  • Dribbling,
  • Poor urine stream,
  • Nocturia,
  • Nocturnal enuresis,
  • Incontinence,
  • Lower abdominal swelling,
  • Can be asymptomatic
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11
Q

What are the differential diagnosis for chronic urinary retention?

A
  • Overactive bladder,
  • Bladder stones,
  • Urethral stricture
  • Neurological bladder
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12
Q

What is high pressure urinary retention?

A

Typically caused by bladder outflow obstruction which results in impaired renal function and bilateral hydronephrosis

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13
Q

What is low pressure retention?

A

Urinary retention with normal renal function and no hydronephrosis

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14
Q

What are the investigations for chronic urinary retention

A
  • History and exam,
  • Urinalysis,
  • Blood tests,
  • Bladder ultrasound,
  • Uroflowmetry to measure urine flow rate,
  • Cystoscopy,
  • Urodynamic studies
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15
Q

What is the management of chronic urinary retention?

A
  • Alleviating obstruction via catheterisation, surgery or meds.
  • Treat underlying cause
  • IV fluids to manage post-obstructive diuresis
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16
Q

What are the complications of chronic urinary retention?

A
  • Post obstructive diuresis - occurs more in chronic,
  • CKD,
  • Hydronephrosis,
  • Bladder diverticula,
  • Decompression haematuria
17
Q

Chronic retention can be divided into what?

A

High pressure or low pressure. High detrusor activity causes high pressure chronic retention

18
Q

What is post obstruction diuresis?

A

Physiological response to retained sodium, water and urea. It occurs when the urine output is >200ml/hr for 2 consecutive hours

19
Q

How do you manage post-obstruction diuresis?

A
  1. Test urine osmolarities.

If iso-osmolar then kidneys do not need to concentrate urine, this is consistent with physiological diuresis and will self-resolve.
Hyperosmolar - kidneys are concentrating the urine so the post-obstructive diuresis is resolving.
Hypo-osmolar - salt wasting. This is pathological so fluids need to be replaced.

20
Q

WHat is obstructive uropathy?

A

It is the blockage of the urine flow through the ureter, bladder and urethra. It leads to back-pressure in the urine system.

21
Q

Explain the presentation of obstructive uropathy

A

Upper UT obstruction - Loin to groin pain, reduced/no urine output, systemic symptoms, impaired renal function
lower UT obstruction - Urinary retention and impaired renal function

22
Q

What are the causes of obstructive uropathy?

A

Upper urinary tract - Kidney stones, tumours, ureter strictures, retroperitoneal fibrosis, cladder cancer, ureterocele
Lower UT obstruction - BPH, prostate cancer, bladder cancer, uretheral strictures, neurogenic bladders

23
Q

What are the investigations for obstructive uropathy?

A
  • Urine dipstick
  • Bloods: FBC, CRP, U&Es
  • Imaging: Ultrasound, CT
24
Q

What is the initial management of obstructive uropathy?

A

Nephrostomy/ureteric stent and antibiotics if signs of infection.
Catheterise if not passing urine

25
Q

What are some complications of obstructive uropathy?

A

Pain, AKI, CKD, Infection, Hydronephrosis, retention

26
Q

What is hydronephrosis?

A

Dilation of the renal pelvis. Managed by treating the underlying cause

Phase 4 Surgery (58 decks)

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