1: Acute and Chronic Urinary Retention

Question 1

What is acute urinary retention

Answer 1

Inability to pass urine

Question 2

In which gender does urinary retention tend to occur

Answer 2

Males (13:1)

Question 3

Why is urinary retention more common in men

Answer 3

Secondary to BPH

Question 4

Describe incidence of urinary retention with age

Answer 4

Increases

Question 5

What are the 4 etiological categories of urinary retention

Answer 5

• Urethral obstruction
• Medications
• Neurological
• Infection/Women

Question 6

What is the most common etiological category of urinary retention

Answer 6

Obstruction

Question 7

What are 5 causes of urethral obstruction

Answer 7

• BPH
• Urethral stricture
• Calculi
• Malignancy
• Constipation

Question 8

What is a cause of acute retention in male children

Answer 8

Posterior urethral valves

Question 9

What medications can cause urinary retention

Answer 9

Anti-cholinergics
Anti-histamines
Opioids
Benzodiezapines

Question 10

What are 5 autonomic causes of acute urinary retention

Answer 10

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

Question 11

What are symptoms of acute urinary retention

Answer 11

Suprapubic pain

Inability to void

Question 12

What are two signs of acute urinary retention

Answer 12

Suprapubic tenderness

Palpable bladder

Question 13

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

Answer 13

Rectal

Neurological

Question 14

What exam should women also receive in acute urinary retention

Answer 14

Pelvic exam

Question 15

What is first line investigation/management for urinary retention

Answer 15

Trans-urethral catheter

Question 16

What type of catheterisation is trialled first

Answer 16

Trans-Urethral

Question 17

If trans-urethral catheter does not work what is placed

Answer 17

Supra-pubic

Question 18

Explain transurethral catheterisation as an investigation for urinary retention

Answer 18

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

Question 19

What does drainage of less than 200ml suggest

Answer 19

No urinary retention

Question 20

What does drainage of more than 400ml suggest

Answer 20

Urinary retention

Question 21

What does drainage 200-400ml indicate

Answer 21

Depends on cause

Question 22

What other investigations may be ordered routinely in acute urinary retention

Answer 22

• Urinalysis
• Urine MC+S
• U+E
• CRP
• FBC

Question 23

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

Answer 23

As PSA is raised in urinary retention

Question 24

In MS if someone has bladder dysfunction what is ordered

Answer 24

Bladder USS

Question 25

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

Answer 25

Intermittent self-catheterisation

Question 26

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

Answer 26

Anti-cholinergics

Question 27

How does NICE define chronic urinary retention

Answer 27

Volume more than 1000ml on post-void bladder scan

Question 28

How do you determine residual volume

Answer 28

Post-void residual bladder volume

Question 29

In which gender is chronic retention more common

Answer 29

Male

Question 30

How is chronic urinary retention divided

Answer 30

Functional | Mechanical

Question 31

What are the 3 mechanical categories of chronic urinary retention

Answer 31

- Urethral - Bladder - Enlarged prostate

Question 32

What is the most common cause of chronic retention

Answer 32

BPH

Question 33

What can cause urethral narrowing

Answer 33

Urethral stricture | TCC

Question 34

What can cause bladder neck obstruction

Answer 34

TCC

Question 35

What causes functional chronic urinary retention

Answer 35

Neurological | Medication

Question 36

What are neurological causes of chromic urinary retention

Answer 36

- Injury to pelvic splanchnic nerves - MS - Stroke - Diabetes

Question 37

What are drug-induced causes of chronic urinary retention

Answer 37

- Anti-cholinergic | - Calcium channel blockers

Question 38

How does chronic urinary retention present clinically

Answer 38

- Painless inability to void urine - Overflow incontinence - New-onset enuresis

Question 39

Why may a new-onset enuresis occur

Answer 39

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

Question 40

How can acute urinary retention be distinguished from chronic urinary retention

Answer 40

- Acute = painful | - Chronic = painless

Question 41

What is acute-on-chronic retention

Answer 41

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

Question 42

How does acute-on-chronic retention present

Answer 42

Painful inability to void with catheterisation volume >800mL

Question 43

What investigations are ordered in chronic urinary retention

Answer 43

- DRE (All males) - Neurological exam - Urinalysis - MSU - U+E (Creatinine)! - Renal USS (Hydronephrosis)!

Question 44

What should be checked for particularly in chronic retention

Answer 44

Creatinine (U+E) | Hydronephrosis (USS)

Question 45

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

Answer 45

Intermittent self-catheterisation or indwelling catheter

Question 46

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

Answer 46

TURP

Question 47

If no bothersome LUTS how is the individual monitored

Answer 47

Active monitoring with - Renal USS for hydronephrosis - U+E for creatinine - Post-residual bladder scan for post-void

Question 48

What are 3 complications of chronic retention

Answer 48

- Acute-on-chronic - UTI - Hydronephrosis

Question 49

What are 4 causes of urethral stricture

Answer 49

- STI - Lichen sclerosis (Balanitis Xeotica obliterates) - Catheterisation - hypospadias