Urinary Retention Flashcards Preview

Renal, Urinary and Bladder > Urinary Retention > Flashcards

Flashcards in Urinary Retention Deck (24):
1

Clinical features of urinary retention?

-Suprapubic pain
-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

2

Ix in urinary retention?

-UEC and Cr
-MSU urine for MCS
-?PSA
-?Cystoscopy
-Bladder scan w/ PVR
-RT U/S hydronephrosis, residual volume

3

Mx acute urinary retention?

-Treat underlying cause
-Catheterise: leave Foley to drain bladder; r/v to determine cause
-Closely monitor fluid status and electrolytes

4

Mx chronic urinary retention?

Intermittent catheterisation by patient commonly used; definite treatment depends on aetiology

5

Mx of post op pts with urinary retention?

-encourage ambulation
-a-blockers to relax bladder neck outlet
-may need catheterisation
-definitive treatment will depend on aetiology

6

Which pts may have falsely elevated PVR measure on bladder scan?

Pts with ascites

7

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)

8

Broad aetiology of urinary retention?

-Outflow obstruction
-Bladder innervation
-Pharmacologic
-Infection

9

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.

10

Causes of urinary retention resulting from change to bladder innervation?

-Intracranial: CVA, tumour, Parkinson's, cerebral pasly
-Spinal cord: injury, disc herniation, MS
-DM
-Post abdo or pelvic surgery

11

Drugs precipitating urinary retention?

-Anticholinergics
-Narcotics
-Antihypertensives (ganglionic blockers)
-OTC cold medications containing ephedrine or pseudo ephedrine
-Antihistamines
-Psychosomatic substances (e.g. ecstasy)

12

Infections causing urinary retention?

-GU: UTI, prostatitis, abscess, genital herpes
-Infected foreign body
-Varicella zoster

13

Irritative LUTS?

IFUND
-Incontinence
-Frequency
-Urgency
-Nocturia
-Dysuria

14

Obstructive LUTS?

SHED
-Straining
-Hesitancy
-Incomplete emptying
-Terminal dribbling

15

Ix in obstructive LUTS?

-MSU
-UEC and Cr
-?PSA
-Bladder diary
-Voiding flow rate
-US: PRV and hydronephrosis

16

Rx obstructive LUTS?

-Observe
-Medical:
--> alpha blockers
--> 5a reductase inhibitors
-Surgical:
--> TURP
--> BNI
--> Open prostatectomy

17

What are the acute precipitants of acute urinary retention?

-UTI
-Diuresis
-Constipation
-Drugs
-Post op
-Bleeding (clot retention)

18

RFx for acute urinary retention?

-Aging
-Established LUTS
-Low urinary flow rate
-Enlarged prostate
-Raised PSA

19

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

20

Initial management in pt w/ AUR?

-Brief history
-Anything complicating catheterisation (PHx TURP, strictures)
-Pass catheter

21

Catheter sizes for man, woman and 3-way haematuria?

-Man: 12-14F
-Woman: 14-16F
-3 way for haematuria: 22-24F

22

What is obstructive nephropathy?

-back pressure from AUR
-renal dysfunction
Defined by elevated Cr and B/L hydronephrosis

23

Mx obstructive neprhopathy?

-Admit
-Monitor urine hourly
-Replace urine output w/ 1/2 volume 0.9% NaCl
-Regular UEC
-Replace Mg2+ / PO43- as required

24

Considerations when commencing pt w/ self catheter?

-Leg bag education (day and night bags)
-Ensure right length of tubing for pt
-Anchor catheter (prevent erosion through urethral meatus --> hypospadias)
-Consider tamsulosin 0.4mg OD
-Consider admission if safety issue