1. Urinary Retention

2. Definition
Inability to empty the bladder completely during attempts to void
Chronic retention leads to overflow incontinence
Residual urine is the amount that remains in the bladder after voiding.
Less than 60yrs of age bladder must be completely empty after voiding
Above 60 yrs of age 50 to 100 ml remains

3. Aetiology
Urinary retention can occur postoperatively in any patient, particularly if the surgery affected the perineal or anal region and resulted in reflex spasm of the sphincters
General anaesthesia suppresses the urge to void
BHP
Diabetes mellitus
Urethral pathology : infection, tumour, calculus
Trauma : pelvic injuries,
Pregnancy
Neurologic disorders such as cerebrovascular accident, spinal cord injury
Drugs : atropine, dicyclomine, imipramine; ephedrine, pseudoephedrine, propranolol oestrogens.

4. Bladder fullness and sensation of incomplete emptying Haematuria
Clinical Features
Bladder fullness and sensation of incomplete emptying
Haematuria
Dysuria
Ultrasound assessment – reveals residual urine

5. Backward pressure in the kidneys
Complications
Infection
Calculi
Pyelonephritis
Sepsis
Backward pressure in the kidneys

6. Promoting normal urinary elimination privacy proper environment
Nursing Management
Promoting normal urinary elimination
privacy
proper environment
position
bathroom
commode rather than bedpan
male patient made to stand beside bed

7. sitz bath, warm compresses to perineum,showers, hot tea, turning on the water faucet stroking the abdomen or inner thighs, tapping above the pubic area and dipping the patient’s hand in warm water
After surgery the prescribed analgesic
Promoting urinary elimination catheterization
Urethral catheter or suprapubic catheter

8. Nursing Management During Catheterization
Monitor color, odour and volume
Pressure at penoscrotal junction in male patients is avoided by proper anchoring
Traction on the bladder is avoided
Observe signs and symptoms of urinary tract infection
The area around the urethra is observed for drainage and excoriation
Do C&S

9. Assessing for age related complications
Typical signs and symptoms of UTI may not be seen in the elderly
Any subtle change in physical condition or mental status  possible infection

10. Catheter anchored to prevent to and fro movement
Preventing infection
Vigorous cleaning of the meatus discouraged since to and fro movts of the catheter ↑ infection
Catheter anchored to prevent to and fro movement
Liberal intake of fluids
Hand hygiene

11. Minimizing Trauma Catheter - Use appropriate size
Lubricate adequately – water soluble
Insert far enough to prevent injury to the urethral tissue when the balloon is inflated
Prevent movements of the catheter – in male patients the drainage tube not the catheter is taped laterally to the thigh to prevent pressure on the urethra at the penoscrotal junction
In female patients drainage tube is taped to the thigh to prevent tension and traction on the bladder

12. Retraining the Bladder
To retrain the detrusor muscle
Timed voiding taught
Completion of drainage by straight catheterization