Download MBBS Urology Presentations 1 Acute And Chronic Retention of Urine Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Urology 1 Acute And Chronic Retention of Urine PPT-Powerpoint Presentations and lecture notes


Acute and chronic retention of

urine & Management

Department of Urology

Urinary retention

? Acute
? Chronic
? Acute on chronic





Physiology of micturition

? Filling phase-bladder distension, sphincter

closed

? Voiding phase- Bladder contracts, sphincter

relaxes

? Mechanical
? Functional
Acute urinary retention (AUR)

? sudden onset, often painful

? Palpable or percussable bladder,

? unable to pass any urine

? Painless

? Spinal cord injury or after

regional anaesthesia

? Chronic urinary retention (CUR)

? non-painful bladder, which

remains palpable or percussable after the

patient has passed urine
? The ability to feel a bladder may rely on

variables including medical skills and patient

habitus:

? Patient able to void-residual urine volume> 300

mL(Abram)

? Patient not able to void-residual urine volume (PVR)

of> 1000 mL.
[UK National Institute for Health and Clinical

Excel ence lower urinary tract symptoms

(LUTS) guidelines


? CUR is generally classified as:
? 1. high pressure
? 2. low pressure

ADULT MALE

1.Mechanical obstruction of the urethra

?BPH
?Urethral stricture
?Prostatic CA
?Bladder neck stenosis
?Bladder CA
?Vesicle or urethral calculi
?Meatal stenosis


2.Inflammatory

?Acute urethritis
?Acute prostatitis
?Prostatic abscess

3.Traumatic

?urethral rupture

4.Prepucial

?Phimosis
?Paraphimosis

5.Neurogenic

post operative

Spinal injury

Spinal dx ? tabes dorsalis, lesions involving cauda

equina, multiple sclerosis


IN FEMALE

? Retroverted gravid uterus ,

Prolapse

? Post operative

? Impacted pelvic mass

? Meatal stenosis

? Bladder neck dyssynergia/Neurogenic bladder

? Vesical/urethral calculi

MALE CHILD
? Meatal ulcer with scabbing
? Meatal stenosis/congenital urethral stenosis
? PUV
? Phimosis/paraphimosis
? Neurogenic-spinal bifida
Pricipitants

?Alcohol

?Surgery

?CVA

?Drugs

?diuretics,

?antticholinergics,

?sympathomimmetics,

?Antidepressants

?Painful perineal conditions

How to diagnose?

? Diagnosis of urinary retention
? Diagnosis of cause of urinary retention
? History:

? Examination

Palpable bladder

-Inv.

USG(Not always necessary)

Other relevant inv.



1

? History

? 70 year male, Difficulty in voiding for several months, has

not passed urine for last 6 hours, pain in the lower abdomen

? Examination

? Suprapubic bulge, dul

? DRE- grade I I, firm, nontender prostate

? Catheterised

v BPH

? No difficulty

v Urethral stricture

v Prostatic CA

? USG

v Bladder neck

? 70 cc Prostate, homogeneous echotexture

stenosis

? ? Dx

v Bladder CA

? Mn: Medical or surgical

v Vesicle or urethral

calculi

v Meatal stenosis


2

? History

? 50 year male, Difficulty in voiding for several months, has not passed urine for

last 6 hours, pain in the lower abdomen

? Examination

? Suprapubic bulge, dull

? DRE- grade II , hard, nodular, irregular boarder non-tender prostate

? Catheterised

? No difficulty

? USG

? 70 cc Prostate, inhomogeneous echotexture, with hypoechoic nodules

? PSA

? 40ng/ml

v BPH

? Dx?

v Urethral stricture

v Prostatic CA

? Mn: Beyond the scope of this class

v Bladder neck

stenosis

v Bladder CA

v Vesicle or urethral

calculi

v Meatal stenosis

3

History

A 40 year old male,

RTA 2 years back

Was in ICU for several days and had prolonged urinary catheterisation

Has thin urinary stream associated with straining during micturition

Multiple febrile episodes associated with dysuria

Frequency of micturition, Dribbling of urine, Nocturnal enuresis

ExamPalpable bladder

v BPH

Grade I firm nontender Prostate

v Urethral stricture

v Prostatic CA

Attempt of catheterisation- failed

v Bladder neck

stenosis

Dx?

v Bladder CA

Inv.

v Vesicle or urethral

-RGU,

calculi

v Meatal stenosis


4

History

v BPH

v Urethral stricture

60 yr old male

v Prostatic CA

TURP 6 months back

v Bladder neck

Poor urinary stream with straining

stenosis

Exam

v Bladder CA

Binge of alcohol last night

v Vesicle or urethral

calculi

Not passed urine since then, pain in suprapubic region v Meatal stenosis

Palpable bladder

Attempt of catheterisation-failed

Dx?

Inv:

-RGU/Cystoscopy

v BPH

5

v Urethral stricture

v Prostatic CA

v Bladder neck

stenosis

History

v Bladder CA

v Vesicle or urethral

65 year old men

calculi

Chain bidi smoker

v Meatal stenosis

Hematuria followed by inability to pass urine for 1 day

Exam

Palpable bladder

Grade I firm nontender P



Catheterise- foleys drained initial y some amount of blood stained

urine, not draining thereafter


Dx?

Inv:


v BPH

v Urethral stricture

6

v Prostatic CA

v Bladder neck

stenosis

v Bladder CA

v Vesicle or urethral

History

calculi

v Meatal stenosis

35 year old male

Last week attack of ureteric colic(diagnosed by NCCT KUB, 10 mm stone in left

lower ureter)

ExamRetention of urine for one day, painful


Attempted catheterisation- resistance felt 1 cm proximal to EUM

Hard structure felt in navicular fossa


Dx?

Inv-

X Ray pelvis

7

v BPH

v Urethral stricture

v Prostatic CA

v Bladder neck

History

stenosis

45 yr old men

v Bladder CA

v Vesicle or urethral

Type I diabetes on insulin, poorly controlled

calculi

Multiple episodes of UTI

v Meatal stenosis

Dysuria, pain in perineum

v Prostatic abscess

Fever with chills

Exam

Retention of urine

Painful DRE, tender prostate, boggy sel ing felt anteriorly


Dx?

Inv:

MRI pelvis/USG/TRUS


8

History

20 year old male

Motercycle accident

Arrived 5 hours later to casuality.

Exam

Bruise in the perineum

Scrotal swelling

Pain in lower abdomen, unable to pass urine

v BPH

Blood at meatus

v Urethral stricture

Failed catheterisation

v Prostatic CA

v Bladder neck



stenosis

Dx?

v Bladder CA

? Mn:

v Vesicle or urethral

? SPC

calculi

v Meatal stenosis

v Urethral trauma

9

v BPH

v Urethral stricture

v Prostatic CA

v Bladder neck

History

stenosis

v Bladder CA

30 yr old female

v Vesicle or urethral

calculi

Fall from tree

v Meatal stenosis

v Spinal cord injury

Unable to move her both limbs, no sensation
Has not passed urine and stool for last 12 hours

Exam

Palpable bladder

Dx?
10

History and Exam

40 year old male

Hernioplasty for right inginal hernia spinal anaesthesia

Retention of urine posoperatively



v BPH

v Urethral stricture

Mn?

v Prostatic CA

SPC

v Bladder neck

stenosis

PUC

v Bladder CA

Suprapubic aspiration

v Vesicle or urethral

calculi

conservative

v Meatal stenosis

v Post spinal

anaesthesia

v BPH

11

v Urethral stricture

v Prostatic CA

v Bladder neck

stenosis

History

v Bladder CA

v Vesicle or urethral

26 year female

calculi

Not passed urine for 3 days

v Meatal stenosis

H/O intake of some herbal medicine for pain in abdomen

Generalised swelling of body, facial edema

Exam Bladder not palpable

Catheterised easily, no urine,

Inv USG- bladder empty

S.Cr-8mg/dl

? Dx-?

Anuria


Management

?catheterization maintaining strict asepsis
?suprapubic cystostomy

? Treat the underlying cause
Complications

? Bladder hypertrophy

Trabeculations
Diverticular formation
Hydroureteronephrosis
Haematuria
Renal failure
Recc UTI
Urolithiasis

Thank you

This post was last modified on 08 April 2022