Urinary retention

Question 1

Test on the ward to confirm someone’s in acute retention

Answer 1

A ward portable bladder scan can be used to scan the bladder to confirm the diagnosis.

Question 2

Management of acute urinary retention

Answer 2

Insert urethral catheter

Record residual volume!

Send urine for MCS

FBC and U&Es- important in case they’ve got renal failure due to high pressure retention

Analgesia if needed

Prescribe alpha blcoker if necessary

Question 3

T/F DRE can be performed accurately when the patient is in retention

Answer 3

It is very important to carry out a Digital rectal examination (DRE) to assess the size, consistency of the prostate. If the DRE is done while the patient is in retention, this will give you an inaccurate estimation due to the pressure exerted on the prostate from the distended bladder, making the prostate seen larger than it is.

Question 4

What should be the management of a patient with BPH who was admitted with urinary retention

Answer 4

Send home with a catheter and alpha blocker therapy. A week later, try without catheter.

Spontaneous retention is more likely to recur after a trial without catheter and will therefore require definitive treatment in the form of a TURP.

50% of patients with spontaneous retention will experience a second episode in the next week or two and 70% within the next year

Question 5

t/f PSA increases with age

Answer 5

T

Question 6

Why does a patient with acute urinary retention need admission if they have affected U&Es

Answer 6

If they’ve had renal failure due to high pressure retention they need to be admitted as they might have a diuresis after

Question 7

What is chronic retention

Answer 7

CUR is postvoid residual >800mL

Gradual increase in residual volume over months and years

Question 8

T/F chronic and acute retention can be low pressure or high pressure

Answer 8

T

Question 9

What is low pressure retention- how to manage

Answer 9

Normal U & Cr, no hydronephrosis

Consider starting alpha blockers, and TWOC a week later

Question 10

What is high pressure retention, how to manage

Answer 10

Raised U and Cr

Bilateral hydronephrosis

Admit.

Measure urinary output, BP, body weight

They might have a large diuresis following retention, and they may need fluid replacement

Only <10% need fluid replacement.

YOU NEVER TWOC

They need BOO surgery or a longterm catheter