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A - MSRA Renal and Urinary [17] > [3] Acute Urinary Retention > Flashcards

[3] Acute Urinary Retention Flashcards

(47 cards)

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1
Q

What is acute urinary retention?

A

The sudden inability to pass urine

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2
Q

Is acute urinary retention painful?

A

Usually

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3
Q

What does acute urinary retention require?

A

Emergency treatment with a urinary catheter

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4
Q

What are the categories of causes of acute urinary retention?

A
  • Obstructive
  • Infectious and inflammatory
  • Drug related
  • Neurological
  • Other
  • Post-operative
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5
Q

What are the obstructive causes of urinary retention in men?

A
  • Benign prostatic hyperplasia
  • Meatal stenosis
  • Paraphismosis
  • Penile constricting bands
  • Phismosis
  • Prostate cancer
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6
Q

What are the obstructive causes of urinary retention in women?

A
  • Prolapse
  • Pelvic mass
  • Retroverted gravid uterus
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7
Q

What kinds of prolapse can cause urinary retention?

A
  • Cystocele
  • Rectocele
  • Uterine
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8
Q

Give three examples of pelvic masses in women that can cause obstructive urinary retention

A
  • Gynaecological malignancy
  • Uterine fibroid
  • Ovarian cyst
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9
Q

What are the obstructive causes of urinary retention in both genders?

A
  • Bladder calculi
  • Bladder cancer
  • Faecal impaction
  • Gastrointestinal or retroperitoneal malignancy
  • Urethral strictures
  • Foreign bodies
  • Stones
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10
Q

What are the infectious and inflammatory causes of urinary retention in men?

A
  • Balantitis
  • Prostatitis
  • Prostatic abscess
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11
Q

What are the infectious and inflammatory causes of urinary retention in women?

A
  • Acute vulvovaginitis
  • Vaginal lichen planus and lichen sclerosis
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12
Q

What are the infectious and inflammatory causes of urinary retention in both genders?

A
  • Cystitis
  • Herpes simplex virus
  • Peri-urethral abscess
  • Varicella-zoster virus
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13
Q

What % of cases of acute urinary retention episodes are thought to be attributable to drugs?

A

10%

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14
Q

What drugs are known to increase the risk of acute urinary retention?

A
  • Anticholinergics
  • Opioids and anaesthetics
  • Alpha-adenoceptor agonists
  • Benzodiazepines
  • NSAIDs
  • Detrusor relaxants
  • Calcium-channel blockers
  • Anti-histamines
  • Alcohol
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15
Q

What kind of retention do neurological problems cause?

A

More often cause chronic retention, but may also cause acute retention

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16
Q

What are the categories of neurological causes of acute urinary retention?

A
  • Autonomic and peripheral nerve pathologies
  • Brain
  • Spinal cord
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17
Q

What autonomic or peripheral nerve pathologies can cause acute urinary retention?

A
  • Autonomic neuropathy
  • Diabetes mellitus
  • Guillain-Barre syndrome
  • Pernicious anaemia
  • Poliomyelitis
  • Radical pelvic surgery
  • Spinal cord trauma
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18
Q

What brain conditions can cause acute urinary retention?

A
  • CVD
  • Multiple sclerosis
  • Neoplasm
  • Normal pressure hydrocephalus
  • Parkinson’s disease
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19
Q

What spinal cord conditions can cause acute urinary retention?

Study These Flashcards
A
  • Intervertebral disc disease
  • Meningomyelocele
  • MS
  • Spina bifida
  • Spinal cord trauma
  • Spinal stenosis
  • Transverse myelitis
  • Tumours
  • Cauda equine
20
Q

What are the other causes of urinary retention in men?

Study These Flashcards
A

Penile trauma, fracture, or laceration

21
Q

What are the other causes of urinary retention in females?

Study These Flashcards
A
  • Post-partum complications
  • Urethral sphincter dysfunction
22
Q

What are the other causes of acute urinary retention in both genders?

Study These Flashcards
A
  • Pelvic trauma
  • Iatrogenic
  • Psychogenic
23
Q

What are the post-operative causes of acute urinary retention?

Study These Flashcards
A
  • Pain
  • Traumatic instrumentation
  • Bladder over-distention
  • Iatrogenic
  • Drugs
  • Decreased mobility and increased bed rest
24
Q

What features make a diagnosis of acute urinary retention usually self-evident?

Study These Flashcards
A

The patient is very uncomfortable and unable to pass urine, with a tender, distended bladder

25
What should history and examination be aimed at in acute urinary retention?
Determining a cause
26
What information should be obtained from the history in AUR?
* Nature and duration of current symptoms * Any other associated symptoms, including fever, weight loss, sensory loss, weakness * Enquire regarding previous episodes of retention and LUTS * Consider precipitants * PMH * Medications
27
What are the potential precipitants for AUR?
* Alcohol consumption * Recent surgery * UTI * Constipation * Large fluid intake * Cold exposure * Prolonged travel
28
What should be included in the examination for AUR?
* Look for signs of fever, and signs of infection/systemic illness * Abdominal examination * Genitourinary examination * PR examination * Neurological examination
29
What may be found on abdominal examination in AUR?
Tender and enlarged bladder with dullness to percussion well above pubic symphysis, often almost to level of umbilicus
30
What should be looked for in men on genitourinary examination in AUR?
* Phismosis or meatal stenosis * Urethral discharge and genital vesicles
31
What should be looked for on genitourinary examination in women?
* Vulval or vaginal inflammation or infection * Cystocele, rectocele, or uterine prolapse * Pelvic mass
32
What should be checked for on PR examination in AUR?
* Anal tone * Prostatic size * Nodules * Tenderness
33
What may be excluded on PR examination in AUR?
Faecal impaction
34
RWhat should be looked for on neurological examination in AUR?
* Evidence of a prolapsed disc or cord compression by checking lower limb power * Check perineal sensation
35
How can you differentiate between acute and chronic urinary retention?
AUR is usually painful. CUR tends to be relatively pain free
36
What investigations are done in AUR?
* Urinanalysis * MSU * Blood tests * Imaging studies
37
What should be checked for on urinalysis in AUR?
* Infection * Haematuria * Proteinuria * Glucosuria
38
What blood tests should be in AUR?
* FBC * U&E * Creatinine * eGFR * Blood glucose * PSA
39
What imaging studies may be done in AUR?
* Ultrasound * CT scan * MRI/CT brain scan * MRI scan of spine * Cystoscopy
40
What is the use of ultrasound in AUR?
* Provides a measure of post-void residual urine * Looks for hydronephrosis and other structural abnormalities of the renal system
41
What is the use of CT scan in AUR?
Used to look for pelvic, abdominal, or retroperitoneal mass causing extrinsic bladder neck compression
42
What is the use of MRI/CT brain scan in AUR?
Looks for intracranial lesions
43
What is the purpose of MRI scan of spine in AUR?
Looks for disc prolapse, cauda equina syndrome, spinal cord compression, or MS
44
How is AUR managed?
Immediate and complete bladder decompression wiht immediate catheteristation
45
What medication should be offered before removal of catheter in AUR?
An alpha-blocker
46
What does secondary management of AUR involve?
Treatment of underlying cause
47
What are the complications of AUR?
* UTIs * AKIs * Post-obstructive diuresis * Post-retention haematuria

A - MSRA Renal and Urinary [17] (17 decks)

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