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Urology > 1: Acute and Chronic Urinary Retention > Flashcards

1: Acute and Chronic Urinary Retention Flashcards

1
Q

What is acute urinary retention

A

Inability to pass urine

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2
Q

In which gender does urinary retention tend to occur

A

Males (13:1)

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3
Q

Why is urinary retention more common in men

A

Secondary to BPH

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4
Q

Describe incidence of urinary retention with age

A

Increases

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5
Q

What are the 4 etiological categories of urinary retention

A
  • Urethral obstruction
  • Medications
  • Neurological
  • Infection/Women
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6
Q

What is the most common etiological category of urinary retention

A

Obstruction

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7
Q

What are 5 causes of urethral obstruction

A
  • BPH
  • Urethral stricture
  • Calculi
  • Malignancy
  • Constipation
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8
Q

What is a cause of acute retention in male children

A

Posterior urethral valves

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9
Q

What medications can cause urinary retention

A

Anti-cholinergics
Anti-histamines
Opioids
Benzodiezapines

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10
Q

What are 5 autonomic causes of acute urinary retention

A
  • MS
  • SCC
  • Stroke
  • PD
  • Damage to pelvic splanchnic nerves
  • Diabetic autonomi neuropathy
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11
Q

What are symptoms of acute urinary retention

A

Suprapubic pain

Inability to void

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12
Q

What are two signs of acute urinary retention

A

Suprapubic tenderness

Palpable bladder

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13
Q

What exam should both men and women have in acute urinary retention

A

Rectal

Neurological

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14
Q

What exam should women also receive in acute urinary retention

A

Pelvic exam

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15
Q

What is first line investigation/management for urinary retention

A

Trans-urethral catheter

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16
Q

What type of catheterisation is trialled first

A

Trans-Urethral

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17
Q

If trans-urethral catheter does not work what is placed

A

Supra-pubic

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18
Q

Explain transurethral catheterisation as an investigation for urinary retention

A

The amount of water drained in 15-minutes is measured.

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19
Q

What does drainage of less than 200ml suggest

A

No urinary retention

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20
Q

What does drainage of more than 400ml suggest

A

Urinary retention

21
Q

What does drainage 200-400ml indicate

A

Depends on cause

22
Q

What other investigations may be ordered routinely in acute urinary retention

A
  • Urinalysis
  • Urine MC+S
  • U+E
  • CRP
  • FBC
23
Q

Why should PSA not be ordered in urinary retention even in BPH suspected

A

As PSA is raised in urinary retention

24
Q

In MS if someone has bladder dysfunction what is ordered

A

Bladder USS

25
Q

In MS if residual volume is more than 500ml what is done

A

Intermittent self-catheterisation

26
Q

In MS if residual volume is less than 500ml what is done

A

Anti-cholinergics

27
Q

How does NICE define chronic urinary retention

A

Volume more than 1000ml on post-void bladder scan

28
Q

How do you determine residual volume

A

Post-void residual bladder volume

29
Q

In which gender is chronic retention more common

A

Male

30
Q

How is chronic urinary retention divided

A

Functional

Mechanical

31
Q

What are the 3 mechanical categories of chronic urinary retention

A
  • Urethral
  • Bladder
  • Enlarged prostate
32
Q

What is the most common cause of chronic retention

A

BPH

33
Q

What can cause urethral narrowing

A

Urethral stricture

TCC

34
Q

What can cause bladder neck obstruction

A

TCC

35
Q

What causes functional chronic urinary retention

A

Neurological

Medication

36
Q

What are neurological causes of chromic urinary retention

A
  • Injury to pelvic splanchnic nerves
  • MS
  • Stroke
  • Diabetes
37
Q

What are drug-induced causes of chronic urinary retention

A
  • Anti-cholinergic

- Calcium channel blockers

38
Q

How does chronic urinary retention present clinically

A
  • Painless inability to void urine
  • Overflow incontinence
  • New-onset enuresis
39
Q

Why may a new-onset enuresis occur

A

As pressure of urethral sphincter is lower at night which can cause fluid to leak

40
Q

How can acute urinary retention be distinguished from chronic urinary retention

A
  • Acute = painful

- Chronic = painless

41
Q

What is acute-on-chronic retention

A

Individual with chronic retention who presents with painful inability to pass urine

42
Q

How does acute-on-chronic retention present

A

Painful inability to void with catheterisation volume >800mL

43
Q

What investigations are ordered in chronic urinary retention

A
  • DRE (All males)
  • Neurological exam
  • Urinalysis
  • MSU
  • U+E (Creatinine)!
  • Renal USS (Hydronephrosis)!
44
Q

What should be checked for particularly in chronic retention

A

Creatinine (U+E)

Hydronephrosis (USS)

45
Q

If individual has raised creatinine or hydronephrosis, how should they be managed

A

Intermittent self-catheterisation or indwelling catheter

46
Q

If individual does not have raised creatinine or hydronephrosis but has bothersome LUTS what is considered

A

TURP

47
Q

If no bothersome LUTS how is the individual monitored

A

Active monitoring with

  • Renal USS for hydronephrosis
  • U+E for creatinine
  • Post-residual bladder scan for post-void
48
Q

What are 3 complications of chronic retention

A
  • Acute-on-chronic
  • UTI
  • Hydronephrosis
49
Q

What are 4 causes of urethral stricture

A
  • STI
  • Lichen sclerosis (Balanitis Xeotica obliterates)
  • Catheterisation
  • hypospadias

Urology (14 decks)

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