Urinary Tract Obstruction

Question 1

What are 5 ways of investigating a urinary tract obstruction?

Answer 1

Flush catheter with 50ml warm saline then aspirate
Insert a suprapubic catheter
Urinary tract ultrasound
Fluid challenge
Remove the catheter to see if it resolves the retention

Question 2

Why would you flush catheter with 50ml warm saline then aspirate and is it a good idea in a patient with haematuria?

Answer 2

Haematuria may cause clot retention - catheter is being blocked by lots of blood
Good idea in haematuria as it will dislodge the clot and let urine/smaller clots/fragments of the large clot pass through the catheter

Question 3

Why would you insert a suprapubic catheter and is it a good idea in a patient with haematuria?

Answer 3

May be used if more comfortable than urethral catheter + if there is urethral damage
Would be unnecessary here as carries high morbidity rise due to potential of perforation of the bowel and severe UTIs

Question 4

Why would you order a urinary tract US and is it a good idea in a patient with haematuria?

Answer 4

To check for structural obstruction e.g. stones

Unnecessary as there is already a clinically indicated cause (large bladder + history of macroscopic haematuria)

Question 5

Why would you give patient a fluid challenge and is it a good idea in a patient with haematuria?

Answer 5

Patient may be slightly dry or to test for hypovolaemia
Haematuria indicates clot retention more than hypovolaemia
- although, you would do a fluid challenge of an obstructive uropathy was ruled out. If hypovolaemia is identified, give IV fluids once catheter is draining (do flush/aspiration first)

Question 6

Haematuria + palpable/large bladder w/ catheter in?

Answer 6

Clot retention

- lots of blood may be being retained and blocking the end of the catheter = no drainage