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

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Department of Urology

Urinary 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, which

remains palpable or percussable after the

patient has passed urine

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? The ability to feel a bladder may rely on

variables 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 rupture

4.Prepucial

?Phimosis

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?Paraphimosis

5.Neurogenic

post operative

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Spinal injury

Spinal dx ? tabes dorsalis, lesions involving cauda

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equina, multiple sclerosis


IN 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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? ? Dx

v Bladder CA

? Mn: Medical or surgical

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v Vesicle or urethral

calculi

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v Meatal stenosis


2

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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 urethral

calculi

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 enuresis

ExamPalpable bladder

v BPH

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Grade I firm nontender Prostate

v Urethral stricture

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v Prostatic CA

Attempt of catheterisation- failed

v Bladder neck

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stenosis

Dx?

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v Bladder CA

Inv.

v Vesicle or urethral

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-RGU,

calculi

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v Meatal stenosis


4

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History

v BPH

v Urethral stricture

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60 yr old male

v Prostatic CA

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TURP 6 months back

v Bladder neck

Poor urinary stream with straining

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stenosis

Exam

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v Bladder CA

Binge 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 bladder

Attempt of catheterisation-failed

Dx?

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Inv:

-RGU/Cystoscopy

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v BPH

5

v Urethral stricture

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v Prostatic CA

v Bladder neck

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stenosis

History

v Bladder CA

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v Vesicle or urethral

65 year old men

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calculi

Chain 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 bladder

Grade 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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6

v Prostatic CA

v Bladder neck

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stenosis

v Bladder CA

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v Vesicle or urethral

History

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 left

lower 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 BPH

v Urethral stricture

v Prostatic CA

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v Bladder neck

History

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stenosis

45 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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calculi

Multiple episodes of UTI

v Meatal stenosis

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Dysuria, pain in perineum

v Prostatic abscess

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Fever with chills

Exam

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 male

Motercycle accident

Arrived 5 hours later to casuality.

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Exam

Bruise in the perineum

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Scrotal swelling

Pain in lower abdomen, unable to pass urine

v BPH

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Blood at meatus

v Urethral stricture

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Failed catheterisation

v 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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calculi

v Meatal stenosis

v Urethral trauma

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9

v BPH

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v Urethral stricture

v Prostatic CA

v Bladder neck

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History

stenosis

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v Bladder CA

30 yr old female

v Vesicle or urethral

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calculi

Fall from tree

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v Meatal stenosis

v Spinal cord injury

Unable to move her both limbs, no sensation

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Has not passed urine and stool for last 12 hours

Exam

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 posoperatively



v BPH

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v Urethral stricture

Mn?

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v Prostatic CA

SPC

v Bladder neck

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stenosis

PUC

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v Bladder CA

Suprapubic aspiration

v Vesicle or urethral

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calculi

conservative

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v Meatal stenosis

v Post spinal

anaesthesia

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v BPH

11

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v Urethral stricture

v Prostatic CA

v Bladder neck

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stenosis

History

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v Bladder CA

v Vesicle or urethral

26 year female

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calculi

Not passed urine for 3 days

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v Meatal stenosis

H/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 empty

S.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 formation
Hydroureteronephrosis
Haematuria
Renal failure
Recc UTI

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Urolithiasis

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