Urinary Retention Flashcards
What are the classifications of urinary retention?
Acute precipitated
Acute spontaneous
Chronic low pressure
Chronic high pressure
What is acute urinary retention?
Painful inability to void with a palpable and percussible bladder in which individual suddenly (over a period of hours or less) becomes unable to voluntarily pass urine
What is chronic urinary retention?
Painless, palpable and percussible bladder after voiding occuring insidiously
What is the difference between the two types of chronic urinary retention?
High pressure retention
- Impaired renal function and bilateral hydronephrosis
- Typically due to bladder outflow obstruction
Low pressure retention
- Normal renal function and no hydronephrosis
What groups is acute urinary attention most common?
Common in M over 60 years, rarely occurring in F
What are the risk factors for acute urinary retention?
Benign prostatic obstruction
UTI
Urethral stricture
Cystocele
Calculi
Alcohol excess
Post-operative in postpartum women
Drugs
Neurological cause
What drugs can cause acute urinary retention?
Anticholinergics
Tricyclic antidepressants
Tntihistamines
Opioids
Benzodiazepines
What are the risk factors for chronic urinary retention?
Primary bladder failure
Longstanding bladder outlet obstruction
- Benign prostate obstruction
- Urethral stricture
How does acute urinary retention present?
Palpable distended urinary bladder either on an abdominal or rectal exam
Lower abdominal tenderness
Painful
Incontinent
What investigations are used in urinary retention diagnosis?
Urinalysis and Culture
U&E
- Creatinine is increased in high pressure chronic but normal in low
FBC and CRP to assess for infection
US
PSA will be raised so no point doing the test
What bladder volume confirms a diagnosis of acute urinary retention?
Over 300 cc
What is the management of acute urinary retention?
Immediate catheterisation to decompress bladder
Treat underlying cause
Give an example of an alpha blocker
Tamsulosin
What is the management of chronic urinary retention?
Immediate catheterisation
UO monitoring
IV fluid
Followed by Clean Intermittent Self-Catheterisation (CISC) if appropriate
Long term catheter
Give complications of urinary retention
UTI
Bladder stones
Outflow incontinence
Post-renal or obstructive renal failure
Post obstructive diuresis, may require IV fluids to correct this
Decompression haematuria, usually does not require further treatment
