urinary retention and haematuria

Question 1

what is acute urinary retention?

Answer 1

the painful inability to pass urine

Question 2

what are the local causes of acute urinary retention?

Answer 2

Bladder outlet obstruction

• BPH, prostate cancer, urethral stricture
• UTI (can cause urethral spinchter closure)
• Constipation
• Pelvic mass

Impaired contractility

• anaesthetic, diuretic, alcohol, drugs
• peripheral or central nerve issues

Question 3

what are the general causes of acute urinary retention?

Answer 3

pharmacological

• anticholinergic side effects of drugs
• anaesthetic drugs
• alcohol intoxication
• alpha sympatheticomimetics

post surgery

• recent catheterisation
• abdo surgery

loss of neuro control

Question 4

what are the S&S of acute urinary retention?

Answer 4

suprapubic pain

inability to pass urine (may dribble)
distended bladder

palpable, dull percussible bladder

prostatic enlargement on PR

signs of neuro disease

Question 5

what InV are done in acute urinary retention?

Answer 5

post-void bladder scan
- shows vol of retained urine

Routine bloods

urine specimen

US of urinary tract
- ?hydronephrosis

cytoscopy

Question 6

what are the treatment options for acute urinary retention?

Answer 6

catheterisation (measure vol drained)

Analgesia (5-10mg morphine)

suprapubic catheterisation

monitor renal function

treat underlying cause

Question 7

what are the complications of acute urinary retention?

Answer 7

AKI (post obstructive diuresis)

UTI risk

renal stones

Question 8

how is haematuria classified?

Answer 8

visible or non-visible

non visible further divided into;

• symptomatic
• asymptomatic

Question 9

what are the causes of haematuria ?

Answer 9

VITAMIN

V (Vascular) – AAA, renal infarction
I (Infective) – cystitis/prostatitis/pyelonephritis, TB
T (Trauma) – urethral (iatrogenic), renal
A (Auto-immune) – GN (IgA, post-streptococcal, vasculitis)
M (Metabolic) – stones (gout, hyperCa, hyperPTH)
I (Iatrogenic) – Warfarin, post-procedure, catheter, exercise, RTx, cyclophosphamide and rifampicin
N (Neoplastic) – prostate, bladder, ureter, kidney

Question 10

what investigations should be done for haematuria?

Answer 10

• Urinalysis
• Baseline bloods
• PSA
• Urinary proteins levels if nephrological cause expected
• Flexible cystoscopy
• Urine cytology
• CT KUB

Question 11

when should haematuria be referred?

Answer 11

2 week wait referral if aged >45 and;

• unexplained visible haematuria without UTI
• visible haematuria that persists after successful UTI treatment

aged >60 and have unexplained non-visible haematuria and either dysuria or raised WCC

Question 12

what is the management of emergency haematuria?

Answer 12

• Establish large calibre IV access if the bleed is large; give crystalloid fluid up to 1000mL if tachycardic or hypotensive.
• Do not catheterize without seeking senior advice if there is any suggestion of lower urinary tract pathology or post-interventional bleeding.
• Irrigation (‘3-way’) catheters may be used to relieve acute symptoms of clot colic or clot retention, but should be placed by experienced staff.
• Send blood for FBC (Hb, WCC), U&E (Na, K), group and save, clotting.