Acute urinary retention Flashcards

1
Q

What is AUR?

A
  • New onset
  • Inability to pass urine (or passing very small quantities)
  • Which subsequently leads to pain and discomfort
  • With significant residual volumes
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2
Q

What is acute-on-chronic retention?

A
  • Chronic retention can enter acute retention
  • Can be due to acute deterioration of underlying pathology that caused chronic retention or a new cause - superimposed onto background of previous cause
  • Minimal discomfort despite LARGE residual volumes
  • More at risk of post-obstructive diuresis due to higher residual volumes
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3
Q

Most common causes of AUR

A
  • BPH
  • Urethral strictures
  • Prostate cancer
  • Others - constipation, severe pain, antimuscarinics, anaesthesia (spinal/epidural), neurological disease (eg MS, parkinsons)
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4
Q

What is detrusor sphincter dyssynergia?

A
  • Lack of co-ordination of detrusor muscle contraction with urethral sphincter relaxation
  • = contraction against closed sphincter
  • Often seen in spinal cord pathology/trauma
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5
Q

Symptoms of acute urinary retention

A
  • Acute suprapubic pain
  • Inability to micturate
  • Associated symptoms of underying cause eg UTI, worsening voiding LUTs, recent change meds
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6
Q

Examination of AUR

A
  • Palpable distended bladder
  • Suprapubic tenderness
  • Fevers, rigors, lethargy may suggest infective cause
  • DRE needed - assess prostate and constipation
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7
Q

Bedside and bloods for AUR

A
  • Post void bladder scan
  • Bloods - FBC, CRP, U&E
  • Post catheterisation - catheterised specimen of urine (CSU) send for MC&S
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8
Q

If patient drains >1000ml on catheterisation, what needs to be ruled out?

A
  • High pressure chronic retention
  • This can have caused bilateral hydronephrosis or AKI
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9
Q

Imaging for AUR if suspect high pressure retention

A

USS of KUB to assess for presence of hydronephrosis

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10
Q

Management of AUR

A
  • Immediate urethral catheterisation
  • Measure volume drained post cathterisation
  • Treat underlying cause eg if BPH Tamsulosin
  • Check CSU for any infection
  • Review meds for potential causes
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11
Q

When is catheter removed in AUR?

A
  • If patients have no evidence of renal impairement do TWOC
  • If history of chronic LUTS or palpable large prostate start on alpha 1 adrenoreceptor blocker (eg Tamsulosin) and have TWOC 72hrs or more after commencing
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12
Q

When is TWOC successful?

A
  • If voids with minimal residual volume (less 50-100ml usually)
  • = successful
  • If not, further TWOCs can be trialled in specialist TWOC clinic but multiple failed attempts may require long term catheter until definitive management can be arranged
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13
Q

Complications of AUR

A
  • If acute on chronic - AKI –> CKD
  • Increase risk UTI and renal stones (due to urine stasis)
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14
Q

What is post obstructive diuresis?

A
  • Urine production exceeding 200 mL per hour for 2 consecutive hours OR
  • Producing greater than 3 L of urine in 24 hours is diagnostic of POD
  • = excessive loss of electrolytes and water
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15
Q
A
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