Urinary retention

Question 1

Neurological causes of retention usually present in what way?

Answer 1

Usually cause chronic retention

Question 2

What is by far the most common cause of acute urinary retention?

Answer 2

BPH

Question 3

Main features of acute urinary retention?

Answer 3

Tender distended bladder, anuria, patient very distressed

Question 4

Main features of examination? (3)

Answer 4

Tender enlarged bladder, dull to percussion, well above the pubic bone

DRE- to check anal tone, prostate size, exclude faecal impaction

Neurological- lower limb power

Question 5

Management of acute retention?

Answer 5

Catheterization with alpha blocker before removal

Question 6

Why is tamsulosin prescribed before removal of catheter?

Answer 6

Increases success rate of trial without catheter

Question 7

Complications of acute retention? (3)

Answer 7

UTI
Acute kidney injury
Post-obstructive diuresis

Question 8

Differences between acute and chronic urinary retention?

Answer 8

Some patients with CUR may not have any symptoms; some may still be able to urinate but experience LUTS

AUR- painful and patient cannot urinate

Question 9

Commonest cause of CUR?

Answer 9

BPH

Question 10

Condition which can cause chronic urinary retention in women aged 20-30?

Answer 10

Fowler syndrome

Question 11

What is the underlying problem in Fowler syndrome?

Answer 11

Failure of the urethral sphincter to relax appropriately

Question 12

Investigations in chronic urinary retention?

Answer 12

Renal function tests- urea, creatinine, eGFR

PSA

Urinalysis and MSSU

Question 13

Management of chronic urinary retention

Answer 13

Self-catheterization
Lifestyle- regulating fluid intake, reducing alcohol and caffeine
Drug therapy e.g. tamsulosin, finasteride, tadalafil

Question 14

Complications of chronic urinary retention? (4)

Answer 14

Acute-on-chronic retention
Detrusor hypertrophy +/- bladder diverticulae
AKI/CKD
Overflow incontinence