Urinary retention

Question 1

What is acute urinary retention?

Answer 1

Unable to pass urine >12hrs, catheterisation producing as much or more urine than normal bladder capacity

Question 2

When may retention not be painful?

Answer 2

In epidural anaesthesia

Failure of afferent pathways

Question 3

What causes acute urinary retention?

Answer 3

Childbirth (esp with epidural)
Vulval or perineal pain (e.g. herpes simple)
Surgery 
Drugs e.g. anticholinergics
Retroverted gravid uterus
Pelvic masses
Neurological disease (e.g. MS, CVA)

Question 4

How is acute urinary retention managed?

Answer 4

Catheterisation maintained for 48hrs until underlying cause is treated

Question 5

What is chronic retention?

Answer 5

Bladder distension eventually causes overflow (so leaking occurs)

Question 6

What causes chronic retention?

Answer 6

Urethral obstruction
Detrusor inactivity
-Autonomic neuropathies (e.g. diabetes)
-Previous overdistension of bladder (e.g. unrecognised acute retention after epidural)

Question 7

How may chronic retention present?

Answer 7

Mimic stress incontinence
Urinary loss may be continuous
Examination reveals distended, non-tender bladder
Diagnosis confirmed by USS

Question 8

How is chronic retention managed?

Answer 8

Intermittent self-catheterisation

Question 9

Why should a woman in labour be encouraged to micturate regularly in labour?

Answer 9

Neglected retention of urine (e.g. because of epidural) may irreversibly damage detrusor
End result may be chronic retention
Consider catheterisation in women unwilling to micturate (not used routinely)