urinary retention

Question 1

urinary retention and types

Answer 1

urinary retention - inability to voluntarily urinate

may be caused by:
- urethral blockage
- drugs - antimuscarinics, sympathomimetics, TCAs

acute - medical emergency, develops over hours, painful

chronic - gradual over months, cannot fully empty bladder

Main type of chronic is BPH
- only in men due to enlarged prostate
- symptoms: urinary retention, urgency, frequency, nocturia

Question 2

drug treatment

Answer 2

acute urinary retention:
- immediate catheterisation for pain
- provide alpha blocker 2+ days before removing catheter

chronic urinary retention:
- catheters long term
- may cause recurrent UTIs, pain and stone formation

BPH:
- alpha blockers (relax smooth muscle)
- pts with enlarged prostate, raised prostate antigens or high risk of progression - 5a reductase inhibitors - finasteride or dutasteride

Question 3

alpha blockers imp points

Answer 3

alfuzosin, doxazosin, tamsulosin, terazosin

avoid if pt has history of:
- micturition syncope (fainting after urinating)
- postural hypotension

as alpha blockers lower BP

SE’s:
- dizziness, postural hypotension
- first dose taken before bed - to reduce hypotensive effect
- lie down if dizziness, fatigue, sweating

Question 4

5a reductase inhibitor imp points

Answer 4

breast disorder
sexual dysfunction

male breast cancer reported - report lumps, pain, nipple discharge

excreted in semen - use condom if partner is of childbearing potential

women of childbearing age should avoid handling crushed/broken tablets

reports of depression and rare suicidal thoughts - stop immediately and refer