Urology: Urinary Retention

Question 1

Outline the pathophysiology of urinary retention

Answer 1

Acute = pain

Chronic (no pain) = 1) low pressure = bladder distended, 2) high pressure = no bladder distension (hydronephrosis = renal failure, emergency)

Question 2

What are the causes of urinary retention

Answer 2

Drugs = anti-muscarinics

Gynaecological masses

Enlarged prostate

Neurological = DM, MS, CES, alcohol, Parkinsons

Infection = stops muscle working

Question 3

In cases of urinary retention what investigations should be performed?

Answer 3

Pelvic US

DRE

Urine dip

Neurological exam

Review drugs

Question 4

How should urinary retention be managed?

Answer 4

Acute = catheter

Enlarged prostate = tamulosin (alpha blocker) to relax muscle in bladder

Question 5

Outline the possible complications of from urinary retention

Answer 5

Obstruction = detrusor hypertrophy = detrusor failure = urgency

Acute renal failure

Chronic renal failure

Question 6

How does urinary retention present?

Answer 6

Chronic = painless

Difficulty starting to urinate

Difficulty fully emptying the bladder

Weak dribble or stream of urine

Loss of small amounts of urine during the day

Inability to feel when bladder is full

Increased abdominal pressure

Lack of urge to urinate

Strained efforts to push urine out of the bladder

Frequent urination

Nocturia (waking up more than two times at night to urinate)