Chronic urinary retention Flashcards
1
Q
What is CUR?
A
- Painless inability to pass urine
- Long standing retention resulting in bladder distension = bladder desensitisation so minimal discomfort
2
Q
Most common causes of CUR
A
- Male - BPH, urethral stricture, prostate cancer
- Women - pelvic prolapse eg cystocele, rectocele or uterine prolapse or pelvic mass eg large fibroid
- Neurological - peripheral neuropathy or UMN disease eg MS or parkinsons
3
Q
symptoms of CUR
A
- Painless
- Associated voiding LUTS
- Overflow incontinence - intravesicle pressure overcomes urinary sphincter (worse at night, nocturnal enuresis as sphincter tone is reduced)
4
Q
Investigations - bedside and bloods for CUR
A
- Post void bladder scan
- Routine bloods - FBC, CRP, U&E
- High pressure chronic retention need USS KUB for hydronephrosis
5
Q
What is high pressure urinary retention?
A
- Urinary retention causing high intravesicular pressure
- Anti-relfux mechanism of ureters and bladders are overcome
- Back flow of urine into upper renal tract
- = hydroureter and hydronephrosis
6
Q
What can repeated episodes of HPUR lead to?
A
- Permanent renal scarring and CKD
7
Q
When does low pressure retention occur?
A
- Patients with retention with upper renal tract unaffected
- Competent urethral valves or reduced detrusor muscle contractility / complete detrusor failure
8
Q
Management of CUR
A
- Catheterised with long term catheter - or intermittent self catheterisation
- No TWOC - concern over repeat renal injury
- Monitor output for post-obstructive diuresis if drain large volumes
9
Q
Cause of post-obstructive diuresis
A
- Loss of medullary concentration gradient = over diurese
- Can worsen AKI
- Monitor urine output for 24hrs if at risk
- Replace 50% of loss with IV fluids to avoid worsening (if >200ml/hr produced for 2hrs or more)
10
Q
Intermittent self catheterisation - how often?
A
- Regular intervals eg every 4-6hrs
- BUT requires good dexterity and patient compliance - not suitable for all
11
Q
A
