Urinary retention

Question 1

Causes of urinary retention?

Answer 1

Obstructive: can be split into mechanical and dynamic
mechanical: PBH, Stricture, clots, stones, constipation
Dynamic: incr. smooth muscle tone, post op pain, drugs

Neurological: pelvic surgery, MS, DM, SPinal injury/compression

Myogenic: over distention of the bladder
post anasthesia or high alcohol intake

Question 2

Features of acute urinary retention?

Answer 2

Suprapubic tenderness and palpable bladder
large prostate on pr
check anal tone and sacral sensation
<1l drained on catheterisation

Question 3

Ix in acute urinary retention?

Answer 3

Bloods: all, plus PSA but prior to a pr
Urine dip and MC+S
Us bladder and kidneys for hydronephrois, pelvic xr

Question 4

Mx of acute urinary retention?

Answer 4

Conservative: analgesia, privacy, walking, hot bath

Catheterise: 3 way if clots and start gent cover
hourly UO and replace (diuresis)
tamsulosin decreases risk of re catheterisation
twoc after 24-73 hrs
more likely to have a succesful twoc if small volume and predisposing factor

Question 5

When would you do a TURP in acute urinary retention?

Answer 5

failed twoc, impaired renal fx, electively

Question 6

Features of chronic urinary retention?

Answer 6

Depends on high pressure or low pressure

High: high detrusor pressure at the end of micturition, typically caused by BOO, gives bilateral hydronephrosi and decr. renal fx

Low pressure: low detrusor pressure at the end of micturition. Large volume retention with a v compliant bladder. Kidney able to excrete fx so less impact up there

Question 7

Presentation of chronic urinary retention?

Answer 7

painless, insidious, high bladder volume (1.5L) can get overflow incontinence and nocturnal enuresis. Can present with acute on chronic retention, UTI, renal failure

Question 8

Mx of chronic urinary retention?

Answer 8

High pressure: catheterise if pain, renal impairment or infection, hourly UO and replace and consider TURP

Low: avoid catheterisation if possible as risks infection, early turp, often will do poorly so need CISC or permanent catheter

Question 9

Advantage of suprapubic catheterisation?

Answer 9

Decr. UTI
Decr. stricture formation
Twoc without removing,
more comfort
mantain sexual fx

Question 10

Disadvantages of suprapubic catheterisation

Answer 10

Need skill

serious complications can occur

Question 11

C/I of suprapubic catheterisation

Answer 11

Known bladder Ca
undiagnosed haematuria
previous lower abdo surgery (adhesions of bowel to abdo wall)