Urinary retention - acute and chronic Flashcards
What is acute urinary retention?
New onset inability to pass urine which leads to pain and discomfort with high residual volumes
What can cause acute urinary retention?
BPH Prostate cancer Urethral strictures UTIs Constipation - external compression Medications Neurological conditions - cauda equina
What is bladder sphincter dysinergy?
Lack of co-ordination of detrusor muscle contraction with urethral sphincter relaxation.
This is often seen with spinal cord injury or after trauma.
Leads to acute urinary retention.
How does acute urinary retention present?
Acute suprapubic pain
Inability to urinate
Palpable distended bladder
If infective cause - may be fever/ systemic symptoms
What investigations are done for acute urinary retention?
DRE
Bloods - FBC, CRP, U+Es
Urine dip / microscopy if suspected infection
Post-void bladder scan to show residual volume
Ultrasound scan may be needed to assess for hydronephrosis
How is acute urinary retention managed?
Urethral catheterisation - measure volume drained.
Treat underlying cause(e.g. tamsulosin or finasteride)
Antibiotics if appropriate
May require a long term catheter if retention comes back after TWOC (trial without catheter)
What are some complications of acute urinary retention?
Post obstructive diuresis
AKI
CKD if multiple episodes
Increased risk of UTIs and urolithiasis due to urinary stasis
What is post obstructive diuresis?
Once retention is resolved using a catheter, the kidneys can over-diurese due to the concentration gradient.
This leads to an AKI
Patient may need fluid replacement
What is chronic urinary retention?
Painless inability to pass urine with significant bladder distention
What can cause chronic urinary retention?
BPH
Prostate cancer
Urethral strictures
Pelvic prolapses - e.g. uterine, rectocele, cystocele
Pelvic masses - e.g. malignancy or large fibroids
Neurological conditions
What can cause chronic urinary retention?
BPH
Prostate cancer
Urethral strictures
Pelvic prolapses - e.g. uterine, rectocele, cystocele
Pelvic masses - e.g. malignancy or large fibroids
Neurological conditions
How does chronic urinary retention present?
Painless urinary retention
Voiding LUTS - weak stream and hesitancy
Reduced functional capacity - ability to store urine before the need to void
Overflow incontinence - typically worse at night (nocturnal enuresis)
Palpable distended bladder on examination
Residual volume > 1000ml
What investigations will be done for chronic urinary retention?
DRE Bloods - FBCs, CRP, U+Es Post void bedside bladder scan Ultrasound to assess for hydronephrosis Neurological examination
What is the management for chronic urinary retention?
Catheterisation with a long term catheter
Monitor for post-obstructive diuresis
Treat the underlying cause
TWOC - trial without catheter. Alternatives if go back into retention are suprapubic or intermittent self catheterisation rather than long term catheters
What are the complications of chronic urinary retention?
UTIs
Bladder calculi (due to stagnant urine)
Repeated episodes can lead to CKD
