Acute Urinary Retention Flashcards Preview

Y3M - Urology > Acute Urinary Retention > Flashcards

Flashcards in Acute Urinary Retention Deck (15)
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1

Definition

New onset of inability to pass urine leading to pain and discomfort with significant residual volumes.

 

More common in older male patients due to enlarged prostate leading to bladder outflow obstruction.

2

What is Acute-on-chronic?

Chronic retention that then enters acute retention either by acute deterioration or new cause.

 

They will present with minimal discomfort despite very large residual volumes.

They should be treated as per acute retention management

3

Causes in men

BPH by far most common

Urethral strictures

Prostate cancer

4

Other causes

UTI can cause urethral sphincter to close

Constipation

Severe pain

Medications like anti-muscarinics or spinal or epidural anaesthesia

Neurological causes like peripheral neuropathy, iatrogenic nerve damage during pelvic surgery, upper motor neurone disease like MS or Parkinsonäs

5

Clinical features

Acute suprapubic pain

Inability to micturate

UTI, change in medication, worsening voiding LUTS might be present as well

6

Examination findings

Palpable distended bladder with suprapubic tenderness

Associated fevers/rigors or lethargy may suggest an infective cause

Ensure to perform a PR examination

7

Investigations

Post-void bedside bladder scan to show residual volume

Routine bloods with FBC, CRP and U&Es

Post-catheterisaiton a CSU (specimen of urine of catheter) should also be sent to assess presence of infection.

USS should also be done of urinary tract to assess for presence of associated hydronephrosis, if this is confirmed repeat should be done following weeks.

8

What is high-pressure urinary retention?

Causing such high intra-vesicular pressure that the anti-reflux mechanism of the bladder and ureters is overcome and backs up into the ureter and leads to hydroureter, hydronephrosis and impairs the kidneys' clearance levels

9

First line of high-pressure urinary retention

Ultrasound

 

It can leads to renal scarring and CKD :(

10

Initial management of acute urinary retention

Immediate urethral catheterisation to resolve retention

Ensure to measure the volume drained.

Underlying cause should be treated e.g. Tamsulosin for enlarged prostate.

Check CSU for any evidence of infection and review patient's medicaiton

11

Post-management management

Large retention volumes >1000ml need to be monitored post-catheterisation for evidence of post-obstructive diuresis.

12

What is post-obstructive diuresis?

The kidneys can over-diurese due to the loss of their medullary concentration gradient.

This leads to worsening AKI

Patients producing >200ml/hr urine output should have around 50% of their urine output replaced by IV fluids to avoid worsening AKI

13

Specific management of high-pressure urinary retention

Catheter needs to be kept in until definitive mangement like TURP due to risk of further episodes of urinary retention causing AKI.

14

What should be done as post-management if there is no evidence of renal impairment.

 

TWOC where the catheter is removed 24-48hrs after insertion.

If patient voids successfully with a minimal residual volume the TWOC is considered successful.

If fail -> re-catheterisation

Further TWOC can be attempted but multiple fails may warrant long-term catheter

15

Complications

AKI -> CKD

UTI

Renal stones