[Uro/Renal] Urinary Retention Flashcards
what can common causes of acute urinary retention (AUR) be categorised under?
- structural
- functional
- pharmacological
what are the structural causes of AUR?
- prostate
- calculi
- constipation
- tumour
- prolapse
what are the functional causes of AUR?
- neurodegenerative
- stroke
- pain/trauma
- infection
what are the pharmacological causes of AUR?
- anticholinergics
- analgesics
- anaesthesia
- beta agonists
- antihistamines
in men, what is AUR usually due to and what can be done?
prostate pathologies
- commence an alpha blocker (e.g. Tamsulosin)
- refer to urology
AUR is rare in women but what can you consider?
detrusor instability
if pts fail simple interventions for AUR, what may they need?
intermittent self-catheterisation (ISC) or long-term catheter (LTC)
what ix would you do for urinary retention?
- DRE - men and women
- urine dip + MCS
- bloods - FBC, U+E, PSA (men)
- imaging - bladder scan, US KUB
- medication review:
- stop anticholinergics
- analgesia if needed
- laxatives for constipation
pt comes in with palpable bladder + abdominal pain. what do you do?
catheterise
pt comes in with palpable bladder + abdominal pain. you catheterised them and investigate further. what do you do next?
- if suspect prostatism → commence alpha blocker
- attempt TWOC (trial without catheter)
you attempt TWOC but retention recurs. what do you do next?
- recatheterise
- refer to urology
what can chronic urinary retention be separated into and what does this depend on?
- high flow CR or
- low flow CR
depends on creatinine or the presence of hydronephrosis
how is chronic urinary retention found?
- incidentally on imaging
- symptomatically as incontinence due to overflow, or acute-on-chronic presentation
how do you investigate for chronic urinary retention?
- FBC
- U+E
- pre and post-void bladder scans
- urologists may progress onto urodynamic studies
what happens if there is no structural cause (e.g. valves or external compression) to be found for chronic urinary retention?
pts develop sx regularly, most will progress to long-term ISC or a LTC for life
pt with chronic urinary retention. no hydronephrosis and normal U+Es.
LPCR
how do you manage LPCR?
- catheter if symptomatic
- monitor LUTS and renal fx
pt with chronic urinary retention. has hydronephrosis / abnormal U+Es.
HPCR
how do you manage HPCR?
- urgent catheter
- definitive mx: ISC, LTC or TURP
TURP = transurethral resection of prostate
acute retention, acute glaucoma, tachycardia. dx?
anticholinergic effects
LUTS with nocturnal enuresis. dx?
HPCR
prolonged large urine production after catheter. dx?
post-obstructive diuresis
what will help you diagnose most common causes of AUR?
- drug chart review
- urine dip
- bloods
a failed TWOC may point towards what?
chronic urinary retention
