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Y4: Urology > Urinary retention > Flashcards

Urinary retention Flashcards

1
Q

What is urinary retention?

A
  • The inability to completely empty bladder of urine
  • Can be acute or chronic
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2
Q

Define acute urinary retention?

A
  • New onset inability to pass urine
  • Subsequently leads to pain and discomfort with significant residual volumes
  • Most common in older patients, typically enlarged prostate leading to bladder outflow obstruction
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3
Q

Define Acute-on-chronic urinary retention?

A
  • Patients with chronic retention who enter acute retention
    • Deterioration of the underlying pathology
    • New cause superimposed on chronic retention
  • Minimal discomfort despite large residual volumes
  • Risk from post-obstructive diuresis
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4
Q

Describe the causes of acute urinary retention?

A
  • Benign prostatic hyperplasia (most common)
  • UTIs, constipation
  • Severe pain
  • Medications
  • Peripheral neuropathy, MS, parkinsons, bladder sphincter dyssynergy
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5
Q

What medications can cause acute urinary retention?

A
  • Opioids
  • Anti-muscarinics
    • Atropine
  • Sympathomimetics
  • Epidural anaesthesia
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6
Q

What is Bladder sphincter dysinergy?

A
  • Lack of co-ordination of detrusor muscle conrtaction with urethral sphincter relaxation
  • Leads to contraction against a closed sphincter
  • Seen with spinal cord pathology or traumatic injury
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7
Q

Clinical features of acute urinary retention?

A
  • Acute suprapubic pain
  • Inability to micturate
  • UTI symptoms, change to medication worsening voiding LUTS
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8
Q

Signs from a examination of someone with acute urinary retention?

A
  • Palpable distended bladder
  • Suprapubic tenderness
  • PR examination to assess for prostate enlargement
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9
Q

Investigations into suspected acute urinary retention?

A
  • Post-void bedside bladder scan
    • Shows volume of retained urine
  • FBC, CRP, U&Es
  • CSU (catheterised specimen of urine)
  • Patients with high pressure retention:
    • US of urinary tract
      • Assess for hydronephrosis
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10
Q

Desribe high-pressure urinary retention?

A
  • Retention causing high intra-vascular pressure
  • Anti-reflux mechanism of bladder and ureters is overcome and backs up into the upper renal tract
  • Leads to hydroureter and hydronephrosis
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11
Q

Describe the management of acute urinary retention?

A
  • Urgent urethral catheterisation
    • Measure volume drained post-catheterisation
    • Large retention volume patients should be monitored for post-obstructive diuresis
  • Treat underlying cause
    • Tamulosin for enlarged prostate (alpha receptor blocker)
    • Antibiotics for infection
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12
Q

Who is at risk from post-obstruction diuresis?

A

Those with a retention volume of around 1000ml

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13
Q

Describe post-obstructive diuresis?

A
  • Loss of medullar concentration gradient following retention
  • Excess urine produced which can cause worsening AKI
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14
Q

Complications of acute urinary retention

A
  • AKI -> CKD if multiple episodes leads to renal scarring
  • UTIs
  • Renal stones due to urinary stasis
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15
Q

What receptors provide the main parasympathetic supply to the bladder?

A

M3 muscarinic receptor

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16
Q

What medication can be trialled fo long-term control as first line in males with acute urinary retention due to BPH?

A

Tamsulosin

17
Q

A patient presents with 600ml in AUR and has no evidence of renal impairment of his bloods, after what time period can a TWOC be trialled?

A

7 days

18
Q

Define chronic urinary retention?

A
  • Painless inability to pass urine
  • Patients with long standing retention
    • => significant bladder distension causing desensitisation
  • ***Patients who pass small amounts of urine but retain large residual volumes are still classified as having chronic urinary retention
19
Q

Describe the causes of chronic urinary retention?

A
  • BPH (most common cause in men)
    • Urethral strictures, prostate cancer
  • In women, pelvic prolapse is a cause
    • cystocele, rectocele, uterine prolape
  • Peripheral neuropathies, MS, Parkinsons
20
Q

Clinical features of chronic urinary retention?

A
  • Painless urinary retention
  • Associated voiding LUTS (weak stream, hesitancy)
  • Overflow incontinence worse at night
  • Palpable distended bladder with no/minimal tenderness
21
Q

Describe the invesitgations for a suspected chronic urinary retention?

A
  • Post-void bedisde bladder scan
  • FBC, CRP, U&Es
  • Patients with features of high-pressure retention require US
22
Q

Describe the management of chronic urinary retention?

A
  • High post void volumes (>1L) or high pressure retention
    • Long term catheter
    • Alternatives: ISC, suprapubic catheter
  • Should not undergo Trial WithOut Catheter (TWOC) before definite management is planned
  • Definitive management depends on the underlying cause
23
Q

Describe ISC?

A
  • Intermittent self catheterisation
  • For patients with chronic retention who do not want a long-term catheter
  • Patients catheterise themselves at regular intervals (4-6hrs)
  • Requires good manual dexterity and patient compliance
24
Q

Complications of chronic urinary retention?

A
  • UTIs and bladder calculi
    • Due to prolonged urinary stasis
  • Repeat episodes of unmanaged high-pressure retention lead to CKD
25
Q

Which major blood vessel provides arterial supply to the bladder?

A

Internal iliac artery

26
Q

Differences between acute and chronic urinary retention

A
27
Q

How can antimuscarinics cause acute urinary retention?

A

Decreased bladdder sensation and detrusor contractility

28
Q

How can sympathomimetics cause acute urinary retention?

A

Increased muscle tone in urethral sphincter

29
Q

How can opioids cause acute urinary retention?

A

Decreased bladder sensation

Y4: Urology (12 decks)

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