URINARY RETENTION Flashcards
What is urinary retention
Inability to voluntarily urinate
What are the causes?
- urethral blockage
- medication
- conditions that intefere with relaxation fo the urethra
- neurogenic causes
- postpartum
- post op
What medication can cause urinary retention?
antimuscairnic
sympathomimetics
tcas
Acute urinary retention
medical emergency
abrupt development over a period of hours
Chronic urinary retention
gradual over months
inability to completely empty bladder
Benign prostatic hyperplasia
most common cause in men -enlarged prostate
Symptoms of BPH
urinary retention
urgency
frequency and nocturia
Acute urinary retention treatment
immediate catheterisation due to the pain
provide alpha-blocker for 2 days before removing catheter
Alpha-blockers example
Alfuzosin
Doxazosin
Tamsulosin
Terazosin
Indomarin
Prazosin
Chronic urinary retention treatment
catheter used long term
may cause recurrent UTIs, urethra trauma, pain and stone formation
catheter associated UTI treatment frequency
7 days
BPH treatment
- alpha-blocker
- if raised prostate antigens, or at high risk of progression = finasteride or dutasteride
Alpha-blockers MOA
Relax smooth muscles in BPH = increase in urinary flow rate and improvement in obstructive symptoms
5a-reductase inhibitor
finasteride
dutasteride
avoid alpha blockers in
history of:
micturition syncope
postural hypotension
side effects of alpha blockers
- dizziness, postural hypotension
- first dose may cause collapse due to hypotensive effect
- take before bed
- lie down if dizziness, fatigue or sweating develop until they feel better
5a-reductase side effects
breast disorder
sexual dysfunction
male breast cancer reported
finasteride: reports of depression and rare cases of suicidal thoughts
Male breast cancer
report lumens, pain or nipple discharge
5a-reductase inhibitors and women
- excreted in semen - use condom, if partner is pregnant or likely to become pregnant
- women of childbearing potential should avoid handling crushed or broken tablets
Finasteride and depression
stop finasteride immediately and inform HCP
Surgery and BPH
- surgery recommended for more severe symptoms
- do not respond to drugs
