Acute urinary retention Flashcards
What is acute urinary retention?
new onset inability to pass urine which leads to pain, discomfort and significant residual volume
What is acute n chronic retention?
Patients with chronic retention can also enter acute retention due to deterioration, may have higher residual volumes than acute
What is the most common cause of acute urinary retention?
BPH
What else can cause acute urinary retention?
urethral strictures, prostate cancer, UTIs, constipation, severe pain, anti- muscarinic s, spinal anaethesia, peripheral neuropathy, iatrogenic nerve damage, upper motor neurone disease, bladder sphincter dysinergy
What is bladder sphincter dysinergy?
lack of coordination of detrusor muscle contraction with urethral sphincter relaxation leading to contraction against a closed sphincter, often seen in spinal cord pathology or traumatic injury
what are the clinical features of acute urinary retention?
acute suprapubic pain and an inability to micturate with symptoms suggesting the cause,
will have a palpable distended bladder, suprapubic tenderness, if have fever and riggers, lethargy may be signs on infective cause
PR should be preformed to check for prostate enlargement and constipation
What investigations should be done for acute urinary retention?
Post void bedside bladder scan
Routine bloods- FBC, CRP and U&E
After inserting a catheter should do a catheterised specimen of urine
ultrasound to check for hydronephrosis is high pressure
What is high pressure urinary retention?
Urinary retention causing high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and backs up into the upper renal tract causing hydrometer and hydronephorisis so impairs the kidneys clearance
How does high pressure urinary retention present?
deranged renal function, hydronephorosis in imaging
What can repeat episodes of high pressure retention cause?
renal scarring and chronic kidney disease
What is the management for acute urinary retention?
immediate urethral catheterisation and measure the volume, causes treated
What is post obstructive diuresis?
the kidneys may over-diurese due to loss of their medullary concentration gradient during catheterisation, this can lead to an AKI
If you have high pressure urinary retention then when can the catheter be removed?
Not until the definitive management is arranged e.g. TURP
What is a TWOC?
Trial without catheter
What are the complications of acute urinary retention?
Acute kidney injury, chronic kidney injury, scarring, UTIs and renal stones
