Acute and chronic retention of
urine & Management
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Department of UrologyUrinary retention
? Acute
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? Chronic? Acute on chronic
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Physiology of micturition
? Filling phase-bladder distension, sphincter
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closed
? Voiding phase- Bladder contracts, sphincter
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relaxes? Mechanical
? Functional
Acute urinary retention (AUR)
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? sudden onset, often painful
? Palpable or percussable bladder,
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? unable to pass any urine? Painless
? Spinal cord injury or after
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regional anaesthesia
? Chronic urinary retention (CUR)
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? non-painful bladder, whichremains palpable or percussable after the
patient has passed urine
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? The ability to feel a bladder may rely onvariables including medical skills and patient
habitus:
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? Patient able to void-residual urine volume> 300
mL(Abram)
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? Patient not able to void-residual urine volume (PVR)of> 1000 mL.
[UK National Institute for Health and Clinical
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Excel ence lower urinary tract symptoms(LUTS) guidelines
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? CUR is generally classified as:? 1. high pressure
? 2. low pressure
ADULT MALE
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1.Mechanical obstruction of the urethra
?BPH
?Urethral stricture
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?Prostatic CA?Bladder neck stenosis
?Bladder CA
?Vesicle or urethral calculi
?Meatal stenosis
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2.Inflammatory
?Acute urethritis
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?Acute prostatitis?Prostatic abscess
3.Traumatic
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?urethral rupture4.Prepucial
?Phimosis
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?Paraphimosis5.Neurogenic
post operative
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Spinal injury
Spinal dx ? tabes dorsalis, lesions involving cauda
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equina, multiple sclerosisIN FEMALE
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? Retroverted gravid uterus ,Prolapse
? Post operative
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? Impacted pelvic mass
? Meatal stenosis
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? Bladder neck dyssynergia/Neurogenic bladder? Vesical/urethral calculi
MALE CHILD
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? Meatal ulcer with scabbing? Meatal stenosis/congenital urethral stenosis
? PUV
? Phimosis/paraphimosis
? Neurogenic-spinal bifida
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Pricipitants?Alcohol
?Surgery
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?CVA
?Drugs
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?diuretics,?antticholinergics,
?sympathomimmetics,
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?Antidepressants
?Painful perineal conditions
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How to diagnose?? Diagnosis of urinary retention
? Diagnosis of cause of urinary retention
? History:
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? Examination
Palpable bladder
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-Inv.USG(Not always necessary)
Other relevant inv.
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1
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? History? 70 year male, Difficulty in voiding for several months, has
not passed urine for last 6 hours, pain in the lower abdomen
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? Examination
? Suprapubic bulge, dul
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? DRE- grade I I, firm, nontender prostate? Catheterised
v BPH
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? No difficulty
v Urethral stricture
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v Prostatic CA? USG
v Bladder neck
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? 70 cc Prostate, homogeneous echotexture
stenosis
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? ? Dxv Bladder CA
? Mn: Medical or surgical
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v Vesicle or urethral
calculi
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v Meatal stenosis2
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? History? 50 year male, Difficulty in voiding for several months, has not passed urine for
last 6 hours, pain in the lower abdomen
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? Examination
? Suprapubic bulge, dull
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? DRE- grade II , hard, nodular, irregular boarder non-tender prostate? Catheterised
? No difficulty
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? USG
? 70 cc Prostate, inhomogeneous echotexture, with hypoechoic nodules
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? PSA? 40ng/ml
v BPH
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? Dx?
v Urethral stricture
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v Prostatic CA? Mn: Beyond the scope of this class
v Bladder neck
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stenosis
v Bladder CA
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v Vesicle or urethralcalculi
v Meatal stenosis
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3
History
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A 40 year old male,RTA 2 years back
Was in ICU for several days and had prolonged urinary catheterisation
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Has thin urinary stream associated with straining during micturition
Multiple febrile episodes associated with dysuria
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Frequency of micturition, Dribbling of urine, Nocturnal enuresisExamPalpable bladder
v BPH
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Grade I firm nontender Prostate
v Urethral stricture
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v Prostatic CAAttempt of catheterisation- failed
v Bladder neck
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stenosis
Dx?
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v Bladder CAInv.
v Vesicle or urethral
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-RGU,
calculi
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v Meatal stenosis4
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Historyv BPH
v Urethral stricture
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60 yr old male
v Prostatic CA
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TURP 6 months backv Bladder neck
Poor urinary stream with straining
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stenosis
Exam
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v Bladder CABinge of alcohol last night
v Vesicle or urethral
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calculi
Not passed urine since then, pain in suprapubic region v Meatal stenosis
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Palpable bladderAttempt of catheterisation-failed
Dx?
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Inv:
-RGU/Cystoscopy
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v BPH5
v Urethral stricture
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v Prostatic CA
v Bladder neck
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stenosisHistory
v Bladder CA
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v Vesicle or urethral
65 year old men
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calculiChain bidi smoker
v Meatal stenosis
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Hematuria followed by inability to pass urine for 1 day
Exam
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Palpable bladderGrade I firm nontender P
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Catheterise- foleys drained initial y some amount of blood stained
urine, not draining thereafter
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Dx?
Inv:
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v BPH
v Urethral stricture
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6v Prostatic CA
v Bladder neck
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stenosis
v Bladder CA
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v Vesicle or urethralHistory
calculi
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v Meatal stenosis
35 year old male
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Last week attack of ureteric colic(diagnosed by NCCT KUB, 10 mm stone in leftlower ureter)
ExamRetention of urine for one day, painful
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Attempted catheterisation- resistance felt 1 cm proximal to EUM
Hard structure felt in navicular fossa
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Dx?
Inv-
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X Ray pelvis
7
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v BPHv Urethral stricture
v Prostatic CA
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v Bladder neck
History
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stenosis45 yr old men
v Bladder CA
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v Vesicle or urethral
Type I diabetes on insulin, poorly controlled
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calculiMultiple episodes of UTI
v Meatal stenosis
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Dysuria, pain in perineum
v Prostatic abscess
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Fever with chillsExam
Retention of urine
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Painful DRE, tender prostate, boggy sel ing felt anteriorly
Dx?
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Inv:
MRI pelvis/USG/TRUS
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8
History
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20 year old maleMotercycle accident
Arrived 5 hours later to casuality.
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Exam
Bruise in the perineum
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Scrotal swellingPain in lower abdomen, unable to pass urine
v BPH
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Blood at meatus
v Urethral stricture
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Failed catheterisationv Prostatic CA
v Bladder neck
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stenosis
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Dx?v Bladder CA
? Mn:
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v Vesicle or urethral
? SPC
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calculiv Meatal stenosis
v Urethral trauma
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9
v BPH
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v Urethral stricturev Prostatic CA
v Bladder neck
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History
stenosis
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v Bladder CA30 yr old female
v Vesicle or urethral
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calculi
Fall from tree
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v Meatal stenosisv Spinal cord injury
Unable to move her both limbs, no sensation
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Has not passed urine and stool for last 12 hoursExam
Palpable bladder
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Dx?
10
History and Exam
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40 year old male
Hernioplasty for right inginal hernia spinal anaesthesia
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Retention of urine posoperativelyv BPH
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v Urethral stricture
Mn?
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v Prostatic CASPC
v Bladder neck
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stenosis
PUC
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v Bladder CASuprapubic aspiration
v Vesicle or urethral
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calculi
conservative
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v Meatal stenosisv Post spinal
anaesthesia
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v BPH
11
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v Urethral stricturev Prostatic CA
v Bladder neck
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stenosis
History
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v Bladder CAv Vesicle or urethral
26 year female
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calculi
Not passed urine for 3 days
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v Meatal stenosisH/O intake of some herbal medicine for pain in abdomen
Generalised swelling of body, facial edema
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Exam Bladder not palpable
Catheterised easily, no urine,
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Inv USG- bladder emptyS.Cr-8mg/dl
? Dx-?
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Anuria
Management
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?catheterization maintaining strict asepsis
?suprapubic cystostomy
? Treat the underlying cause
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Complications? Bladder hypertrophy
Trabeculations
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Diverticular formationHydroureteronephrosis
Haematuria
Renal failure
Recc UTI
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UrolithiasisThank you