UROLOGY - URINARY RETENTION Flashcards
What is acute urinary retention?
When a person suddenly (over an hour or less) becomes unable to voluntarily pas urine
Who is acute urinary retention most common in?
Men:women 13:1
Mostly over 60s
What causes acute urinary retention?
Mostly secondary to BPH
Urethral obstructions such as strictures, calculi, cystocele, constipation, mass
Meds - anticholinergic, TCA, antihistamines, opioids, benzos
Neurological causes
UTI
Post operatively and postpartum
How does acute urinary retention present?
Inability to pass urine
Lower abdominal discomfort
Considerable pain or distress
an acute confusional state may also be present in elderly patients
How does acute urinary retention present differently to acute-on-chronic urinary retention?
Acute on chronic tends to be painless and just present with overflow incontinence
How should you investigate acute urinary retention?
Urinalysis and culture
Serum U&Es and Cr - to assess for AKI
FBC and CRP
Confirm diagnosis using bladder USS (volume >300 confirms it)
Whats a complication of acute urinary retention?
Post-obstructive diuresis
What is post-obstructive diuresis?
the kidneys may increase diuresis due to the loss of their medullary concentration gradient. This can take time re-equilibrate
this can lead to volume depletion and worsening of any acute kidney injury
How is acute urinary retention managed?
Decompression of the bladder via catheterisation
How does chronic urinary retention present?
Painless and insidious!
Whats the aetiology of chronic urinary retention?
High pressure retention - impaired renal function and bilateral hydronephrosis typically due to bladder outflow obstruction
Low pressure retention - normal renal function and no hydronephrosis
Why does decompression haematuria occur after catheterisation for chronic urinary retention?
Due to the rapid decrease in bladder pressure
