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