Urinary Retention & Urinary Obstruction Flashcards
What are the features of acute urinary retention?
Sudden inability to pass urine
Painful
Emergency: catheterise
Name some causes of acute urinary retention
Prolapse Phimosis or paraphimosis Anticholinergics NSAIDs Opioids Alcohol Diabetes mellitus Spinal cord trauma
What is the initial management for acute urinary retention?
Bladder compression immediately
Men with AUR should be immediately catheterised
An alpha blocker should be offered before catheterisation
Name some causes of chronic urinary retention
Urethral strictures Antihistamines Antispasmodics Anticholinergics BPH is the most common cause Fowler's syndrome (women: problem with sphincter)
What are the investigations of chronic urinary retention?
Voiding diary PSA U&E/Creatinine Urinalysis MSU Blood glucose Urodynamic studies Ultrasound
What is the management of chronic urinary retention?
Intermittent catheterisation
Serum creatinine
Alpha blocker such as tamsulosin
What does an acute upper tract obstruction present like?
Radiates loin to groin
May be superimposed infection and loin tenderness
What does a chronic upper tract obstruction present like?
Flank pain
Renal failure
What does an acute lower tract obstruction present like?
Severe suprapubic pain and acute confusion
Distended, palpable bladder
Urethral strictures, prostatic obstruction, anticholinergics and blood clots and alcohol can cause this
What does a chronic lower tract obstruction present like?
Urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence
Distended palpable bladder
Prostatic enlargement, pelvic malignancy can cause this
What imaging can be used for functional assessment of the kidneys?
Radionuclide imaging
What is the treatment of an upper urinary tract obstruction?
Nephrostomy or ureteric stent
What is the treatment of a lower urinary tract obstruction
Insert a urethral or suprapubic catheter to relieve acute urinary retention
If in clot retention the patient will need a three way catheter
What is obstructive uropathy?
Due to an obstruction, urine flows in the reverse direction back to your kidneys
Place a catheter and ask for an urgent renal US
Respiratory compensated metabolic acidosis is likely to occur
