FN: Urinary Retention Flashcards Preview

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Flashcards in FN: Urinary Retention Deck (22):
1

Causes

Obstructive
Neurological
Myogenic

2

Obstructive causes

Mechanical
Dynamic

3

Mechanical

BPH
Urethral stricture
Clots, stones
Constipation

4

Dynamic

Increased smooth muscle tone (alpha-adrenergic)
- post operative pain
Drugs

5

Neurological

Interruption of sensory or motor innervation
- pelvic surgery
- MS
- DM
- Spinal injry/compression

6

Myogenic

Over-distension of the bldder
- post anaesthesia
- high EtOH intake

7

Acute urinary retention (AUR) clinical features

Suprapubic tenderness
Palpable bladder
- dull to percussion
- Cant get beneath it

Large prostate on PR - check anal tone and sacral sensation

8

Investigations

Blood: FBC, U+E, PSa (prior to PR)
Urine: dip, MC+S
Imaging:
- Us: bladder volume , hydronephrosis
- Pelvic XR

9

Mx conservative

analgesia
Privacy
Walking running water or hot bath

10

Catheterise

Use correct catheter e.g. 3- way if clots
± stat gen cover
Hrly UO + replace: post-obstruction diuresis
TWOC after 24-72 h
- may d/c and f/up in OPD
more likely to be successful if predisposing factor and lower residual volume

11

Medical Mx alongside Cather

Tamsulosin: reduces risk of recatheterisation after retention

12

TURP

Failed TWOC
Impaired renal function
Elective

13

Chronic Urinary retention classification

high pressure
Low pressure

14

high pressure

- high detrusor pressure @ end of micturition
Typically bladder outflow obstruction
- bilateral hydronephrosis and reduced renal function

15

Low pressure

Low detrusor pressure @ end of micturition
LArge volume retention with very compliant bladder
Kidney able to excrete urine
No hydronephrosis therefore normal renal function

16

Presentation

Insidious as bladder capacity increased (>1.5 L)
Typically painless
Overflow incontinence/nocturnal enuresis
Acute on chronic retention
Lower abdo mass
UTI
Renal failure

17

Ma high pressure

Catheterise if
-renal impairement
- pain
- infection

Hrly U + replace: post-obstruction diuresis
Sonsider TURP before TWOC

18

Low Pressure Mx

Avoid catheterisation if possible - risk of introducing infection

Early TURP
- often do poorly due to poor detrusor function
- need CSIC or permanent catheter

19

Suprapubic Catheter advantages

reduces UTIs
Reduces stricture formation
TWOC w/o catheter removal
Pt . preference: increased comfort
Maintain sexual function

20

Suprapubic Catheter disadvantages

More complex: need skills
Serious complications can occur

21

Suprapubic Catheter CI

- known or suspected bladder carcinoma
- Undiagnosed haematuria
-Previous lower abdominal surgery - adhesion of small bowel to abdo wal

22

Clean intermittant self catheterisation

Alternative to indwelling catheter in AUR and CUR
Also useful in pts. who fail to void after TURP

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