Flashcards in Urinary Retention Deck (24):
Clinical features of urinary retention?
-Abdo: Palpable / percussible bladder
-Genitalia: phimosis / balanitis / meatal stenosis / epididymitis / Possible purulent or bloody meatal d/c
-DRE: CaP? Reduced anal sphincter tone? BPH?
-If neurological: altered reflexes, reduced anal wink, saddle anaesthesia
Ix in urinary retention?
-UEC and Cr
-MSU urine for MCS
-Bladder scan w/ PVR
-RT U/S hydronephrosis, residual volume
Mx acute urinary retention?
-Treat underlying cause
-Catheterise: leave Foley to drain bladder; r/v to determine cause
-Closely monitor fluid status and electrolytes
Mx chronic urinary retention?
Intermittent catheterisation by patient commonly used; definite treatment depends on aetiology
Mx of post op pts with urinary retention?
-a-blockers to relax bladder neck outlet
-may need catheterisation
-definitive treatment will depend on aetiology
Which pts may have falsely elevated PVR measure on bladder scan?
Pts with ascites
Contrast acute and chronic retention?
Acute retention is a medical emergency characterised by PAIN and anuria with normal bladder volume and architecture. Acute over distention can lead to bladder rupture.
Chronic retention can be asymptomatic with greatly increased bladder volume and detrusor hypertrophy followed by atony (late)
Broad aetiology of urinary retention?
Causes of outflow obstruction precipitating urinary retention?
-Bladder neck or urethra: calculus, clot, foreign body, neoplasm, neurological
-Prostate: BPH, prostate cancer
-Urethra: stricture, phimosis, traumatic disruption
-Miscellaneous: constipation, pelvic mass.
Causes of urinary retention resulting from change to bladder innervation?
-Intracranial: CVA, tumour, Parkinson's, cerebral pasly
-Spinal cord: injury, disc herniation, MS
-Post abdo or pelvic surgery
Drugs precipitating urinary retention?
-Antihypertensives (ganglionic blockers)
-OTC cold medications containing ephedrine or pseudo ephedrine
-Psychosomatic substances (e.g. ecstasy)
Infections causing urinary retention?
-GU: UTI, prostatitis, abscess, genital herpes
-Infected foreign body
Ix in obstructive LUTS?
-UEC and Cr
-Voiding flow rate
-US: PRV and hydronephrosis
Rx obstructive LUTS?
--> alpha blockers
--> 5a reductase inhibitors
--> Open prostatectomy
What are the acute precipitants of acute urinary retention?
-Bleeding (clot retention)
RFx for acute urinary retention?
-Low urinary flow rate
Causes of female acute urinary retention?
-REFLEX: urethritis / UTI
-INTRINSIC COMPRESSION: meatal stenosis / stricture, tumour, urethral diverticulum / stone
-EXTRENSIC COMPRESSION: severe prolapse, pelvic space occupying lesion
Initial management in pt w/ AUR?
-Anything complicating catheterisation (PHx TURP, strictures)
Catheter sizes for man, woman and 3-way haematuria?
-3 way for haematuria: 22-24F
What is obstructive nephropathy?
-back pressure from AUR
Defined by elevated Cr and B/L hydronephrosis
Mx obstructive neprhopathy?
-Monitor urine hourly
-Replace urine output w/ 1/2 volume 0.9% NaCl
-Replace Mg2+ / PO43- as required