Urinary retention Flashcards
How can you pick up chorda equina syndrome from just acute bladder symptoms?
Feel for the reduced anal tone. Incontinence.
Symptoms are only around pelvis and perineum.
all normal LL & UL.
What are the (3) reasons why indewelling catheter may not drain?
○ Renal failure/no urine (e.g. ovarian cyst)
○ Blocked catheter
○ Wrong hole or not fully in the bladder
Does cystitis cause fever?
No
What (3) conditions does urinary symptoms + fever indicate?
- prostatitis
- orchitis (inflammation of testes)
- pyelonephritis
Can urinary symptoms lead to hydronephrosis & renal failure?
Yes (due to back pressure)
Describe acute urinary retention
- its possible causes
- Rx
· = sudden & PAINFUL inability to pass urine
· Acute urinary symptoms CAN occur idiopathically without any precipitating factors.
· Bleeding (clot retention)
· Fix by putting in a catheter -> retention goes away with pain = acute urinary retention. If not, something else.
· If the catheter does not go in: stricture etc. Mx with suprapubic aspirate.
Describe chronic urinary retention
- its possible causes
- Rx
· Gradual & PAINLESS inability to pass urine
· Neurogenic
· Central
· Peripheral (DM)
· Longterm voiding dysfunction with decompensated detrusor
· Aging
What are the (3) causes of obstructive LUTS?
- BPH
- Ca prostate
- Stricture (scarring of urethra due to instrumentation, radiotherapy, STI, pelvic fracture, perineum trauma)
What are the causes of irritative LUTS?
· Secondary to obstruction · UTI · Ca bladder (irritable, old age, smokers) -> cystoscopy · Massive ovarian cyst · Ca Cervix · Bladder Stones (due to obstructions) · Diabetes · Neurological disorders (spinal injury, MS; can first present with bladder symptoms, strokes, parkinson's) · TB
What are precipitants of LUTS?
○ Medication (anticholinergic/sympathicomimetic)
○ UTI
○ Diuresis (alcohol)
○ Postoperative (pain, anesthetic, analgesics, loss of mobility)
What are (3) conditions related to BPH?
- Urethral stricture
- Pelvic trauma
- Cancer
(4) Px of obstructive LUTS
· Poor flow
· Hesitancy
· Intermittency
· Terminal dribbling
(4) Px of irritative LUTS
· Frequency
· Urgency
· Nocturia
· Incontinence
How can obstructive lead to irritative symptoms?
○ as urine does not empty properly & lead to bacterial infection.
○ Thickening of the bladder wall (irritable) -> over activity of the bladder like AF (compare bladder to the heart with cardiomyopathy etc)
Ix of LUTS
- MSU
- U/E & Cr
- Bladder diary
- Voiding flow rate
- US of bladder, prostate, kidneys: residual urine & hydronephrosis
- Renal function test
- ?PSA marker for prostate cancer. It is a screening test.
What would you check on examination for LUTS
• Abdomen: palpable/percussible bladder?
• Genitalia: phimosis/balanitis/meatal stenosis/epididymitis (prostatitis -> acute urinary symptoms, fever etc)
• DRE: CaP? Rectal mass? (prostate size)?
○ Size of the prostate
○ Benign feeling gland
○ Look for pelvic mass
○ Texture of the glands
○ Faecal impaction: big faeces in urinary retention.
○ Anal tone: affected by neurological defect.
○ DRE for BPH however size does not give too much information for the Dx of underlying cause. Hard prostate (cancer). Only advanced cancers cause symptoms.
• Residual urine
• Focused neurological
What drugs can cause polydipsia?
diabetes, lithium management for bipolar disorder
How can you Rx urinary retention?
- Observe
- Establish drainage: indwelling urethral catheter, intermittent self catheterisation, suprapubic catheter
• Treat with medical treatment
○ Alpha blockers (for mild symptoms). Works acutely.
○ 5-alpha reductase inhibitors. Takes 6 months to work & only works in large prostate with PSA as a guideline. It can prevent and reduce the prevalence of cancer but if you already have cancer, it may cause high grade cancer.
○ Combination
• Treat with surgical treatment
○ TURP: Transurethral resection of prostate 95% satisfaction rates
○ BNI: bladder neck incisions for smaller prostates.
Open prostatectomy: Millen’s prostectomy
