Urinary Retention Flashcards
Clinical features of urinary retention?
- Suprapubic pain
- Abdo: Palpable / percussible bladder
- Genitalia: phimosis / balanitis / meatal stenosis / epididymitis / Possible purulent or bloody meatal d/c
- DRE: CaP? Reduced anal sphincter tone? BPH?
- If neurological: altered reflexes, reduced anal wink, saddle anaesthesia
Ix in urinary retention?
- UEC and Cr
- MSU urine for MCS
- ?PSA
- ?Cystoscopy
- Bladder scan w/ PVR
- RT U/S hydronephrosis, residual volume
Mx acute urinary retention?
- Treat underlying cause
- Catheterise: leave Foley to drain bladder; r/v to determine cause
- Closely monitor fluid status and electrolytes
Mx chronic urinary retention?
Intermittent catheterisation by patient commonly used; definite treatment depends on aetiology
Mx of post op pts with urinary retention?
- encourage ambulation
- a-blockers to relax bladder neck outlet
- may need catheterisation
- definitive treatment will depend on aetiology
Which pts may have falsely elevated PVR measure on bladder scan?
Pts with ascites
Contrast acute and chronic retention?
Acute retention is a medical emergency characterised by PAIN and anuria with normal bladder volume and architecture. Acute over distention can lead to bladder rupture.
Chronic retention can be asymptomatic with greatly increased bladder volume and detrusor hypertrophy followed by atony (late)
Broad aetiology of urinary retention?
- Outflow obstruction
- Bladder innervation
- Pharmacologic
- Infection
Causes of outflow obstruction precipitating urinary retention?
- Bladder neck or urethra: calculus, clot, foreign body, neoplasm, neurological
- Prostate: BPH, prostate cancer
- Urethra: stricture, phimosis, traumatic disruption
- Miscellaneous: constipation, pelvic mass.
Causes of urinary retention resulting from change to bladder innervation?
- Intracranial: CVA, tumour, Parkinson’s, cerebral pasly
- Spinal cord: injury, disc herniation, MS
- DM
- Post abdo or pelvic surgery
Drugs precipitating urinary retention?
- Anticholinergics
- Narcotics
- Antihypertensives (ganglionic blockers)
- OTC cold medications containing ephedrine or pseudo ephedrine
- Antihistamines
- Psychosomatic substances (e.g. ecstasy)
Infections causing urinary retention?
- GU: UTI, prostatitis, abscess, genital herpes
- Infected foreign body
- Varicella zoster
Irritative LUTS?
IFUND
- Incontinence
- Frequency
- Urgency
- Nocturia
- Dysuria
Obstructive LUTS?
SHED
- Straining
- Hesitancy
- Incomplete emptying
- Terminal dribbling
Ix in obstructive LUTS?
- MSU
- UEC and Cr
- ?PSA
- Bladder diary
- Voiding flow rate
- US: PRV and hydronephrosis
Rx obstructive LUTS?
- Observe
- Medical:
- -> alpha blockers
- -> 5a reductase inhibitors
- Surgical:
- -> TURP
- -> BNI
- -> Open prostatectomy
What are the acute precipitants of acute urinary retention?
- UTI
- Diuresis
- Constipation
- Drugs
- Post op
- Bleeding (clot retention)
RFx for acute urinary retention?
- Aging
- Established LUTS
- Low urinary flow rate
- Enlarged prostate
- Raised PSA
Causes of female acute urinary retention?
- REFLEX: urethritis / UTI
- INTRINSIC COMPRESSION: meatal stenosis / stricture, tumour, urethral diverticulum / stone
- EXTRENSIC COMPRESSION: severe prolapse, pelvic space occupying lesion
Initial management in pt w/ AUR?
- Brief history
- Anything complicating catheterisation (PHx TURP, strictures)
- Pass catheter
Catheter sizes for man, woman and 3-way haematuria?
- Man: 12-14F
- Woman: 14-16F
- 3 way for haematuria: 22-24F
What is obstructive nephropathy?
-back pressure from AUR
-renal dysfunction
Defined by elevated Cr and B/L hydronephrosis
Mx obstructive neprhopathy?
- Admit
- Monitor urine hourly
- Replace urine output w/ 1/2 volume 0.9% NaCl
- Regular UEC
- Replace Mg2+ / PO43- as required
Considerations when commencing pt w/ self catheter?
- Leg bag education (day and night bags)
- Ensure right length of tubing for pt
- Anchor catheter (prevent erosion through urethral meatus –> hypospadias)
- Consider tamsulosin 0.4mg OD
- Consider admission if safety issue
