Urinary retention Flashcards
What is urinary retention
Inability to PASS urine
Contrast acute and chronic
Acute: residual volume less than 1000ml, painful, pain relieved by drainage
Chronic: residual volume more than 1000ml, painless, usually an upper tract insult as a result
Types of chronic
High pressure - renal impairment
Low pressure - no renal impairment
Causes
Enlarged prostrate Constipation UTI Neurodistension Cauda equina MS Urethral blockage e.g stricture, phimosis, clot, FB Previous urological surgery
History for retention
When LUTS/UI Pain Precipitating factor Bowel movements UTI Dx
What is enuresis
Involuntary urination
Most likely diagnosis for old men with nocturnal enuresis
Chronic urinary retention with overflow incontinence
What do you need to examine for in urinary retention
Palpable bladder Baseline obs External genitalia Anal tone Anal sensation Neurological examination lower limbs
Investigations for urinary retention
Bedside: urine dipstick, baseline obs
Bloods: FBC, Us and Es
Imaging: bladder US
Special tests: urine MCS
Management for retention
Catheterise (urethral if possible, then suprapubic)
Record RV after catheterisation
Repalpate abdomen
Record fluid input and output
Acute management
Treat underlying cause
Give tamsulosin (alpha blocker)
TWOC for 2-14 weeks
If fail TWOC, do TURP
Chronic management
Long term catheter
TURP
