Acute and chronic urinary retention Medrockets.com

outline Introduction Epidermiology Aetiology Precipitants Clinical features Investigations Prognosis conclusion Medrockets.com

introduction Urinary retention is said to occur when a patient is unable to void despite d distention of bladder with urine TYPES ACUTE, CHRONIC, ACUTE-ON-CHRONIC Medrockets.com

Acute retentention-there is sudden overdistention of d bladder associated with severe hypogastric pain due to ischemia of d bladder muz Chronic retention – distention of bladder with residual urine is gradual.it is ass with dribbling or overflow incontinence Medrockets.com

epidermiology Is a common presentation of BOO About 75% of px with benign prostatic hyperplasia in developing country present with acute retention Medrockets.com

aetiology ADULT MALE 1.Mechanical obstruction of the urethral BPH Urethral stricture Prostatic CA Bladder neck stenosis Bladder CA Vesical or urethral calculi Meatal stenosis Medrockets.com

C’td INFLAMMATORY Acute urethritis Acute prostatitis Prostatic abscess TRAUMATIC urethral rupture

aetiology PREPUCE Phimosis Paraphimosis NEUROGENIC post operative Spinal injury Spinal dx – tabes dorsalis,lesions involving d caudal eguina,multiple sclerosis Medrockets.com

aetiology IN FEMALE Retroverted gravid uterus Post operative Impacted pelvic mass Meatal stenosis Bladder neck dyssynergia Vesical/urethral calculi Medrockets.com

aetiology MALE CHILD Meatal ulcer with scabbing Meatal stenosis/congenital urethral stenosis PUV Phimosis/paraphimosis Neurogenic-spinal bifida Medrockets.com

precipitants alcohol Surgery CVA Drugs eg diuretics,antticholinergics,sympathomimmeti cs,antidepressants Painful perineal conditions

CliNICAL FEATURES ACUTE - sudden inability to void urine with severe excruciating pain except in the transection of d cord Suprapubic swelling o/e bladder is distended and tender

CliNICAL FEATURES CHRONIC Little or no pain Dribbling has been present 4 some time o/e – the bladder may be up to d level of d umbilicus. Rarely may be difficult to feel d bladder Most px have had symptoms of BOO - LUTS Medrockets.com

diagnosis It depends on d age of d px Clinical findings and Results of investigations

management Resuscitation History o/e Investigations Tx Medrockets.com

acute acute retention is a surgical emergency Admit the patient RELIEVE the obstruction first Further mgt depend on d aetiological finding Medrockets.com

hISTORY Urethral stricture Px is relatively younng <45 Past hx of urethritis Urethral injury Failure to pass catheter BPH >45 No hx of urethritis in vast majority of px Medrockets.com

Hx of painless haematuria CA prostate Patient usu >65 Weightloss Back pain , haematuria Bladder CA >50 years Hx of painless haematuria Medrockets.com

Urethritis and prostatitis Hx of dysuria and burning sensation in the urethral on micturition Hx of urethral discharge Vesical or urethral calculi Retention occur suddenly during micturition There may have been freguency by day Terminal pain in the perineum $ tip of d penis ,strangury and haematuria Neurogenic bladder hx of spinal injury distention is painless Medrockets.com

examination GPE- restless,may be in painful distress, +/_pale ,fibrile in complicated cases ABDOMEN Suprapubic swelling with loss of crease Suprapubic tenderness On palpatn – can get above it and not below it Percussion – stony dull non shifting

Digital rectal examination BPH CA of prostate Prostatitis/prostatic abscess

External genitalia Stricture – induration at ventral aspect Meatal stenosis Phimosis- preputial opening is narrow and the prepuce balloons during micturitn

investigations RUCG –shows stricture MCUG – BPH, filling defect in ca of prostate,a dillated posterior urethral in PUV Abd pelvic USS – sricture,BPH,CA,calculi,status of upper tract Urethroscopy-bladder CA +biopsy,calculi Others – PSA,urinalysis, E U $CR FBC urine mcs Medrockets.com

treatment ACUTE- immediate relieve of obstruction by catheterizatn maintaining strict asepsis .suprapubic cystostostomy -diazepam 10mg is given for sedation -antibiotics prophlaxis gentamycin CHRONIC - Urgent E U CR Catheterize Correct fluid and electrolyte derangement Medrockets.com

Correct anaemia and acidosis Avoid rapid decompression bleeding postobstructive diuresis Treat the underlying cause

Urethrogram showing a posterior urethral stricture secondary to sexually transmitted urethritis.

Complications Bladder hypertrophy Trabeculations Diverticular formation Hydroureter; bilateral Hydronephrosis Haematuria Renal failure Reduced quality of life Recc UTI Urolithiasis Medrockets.com

conclusion The mgt of urinary retention depends on d presentation-acute or chronic and the underlying aetiology.prompt intervention is important in preventing attending morbidity and mortality.

THANKS Medrockets.com