1. Acute and chronic urinary retention
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2. outline Introduction Epidermiology Aetiology Precipitants
Clinical features
Investigations
Prognosis
conclusion
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3. 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
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4. 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
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5. epidermiology Is a common presentation of BOO
About 75% of px with benign prostatic hyperplasia in developing country present with acute retention
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6. 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
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7. C’td INFLAMMATORY Acute urethritis Acute prostatitis Prostatic abscess
TRAUMATIC
urethral rupture

8. aetiology PREPUCE Phimosis Paraphimosis NEUROGENIC post operative
Spinal injury
Spinal dx – tabes dorsalis,lesions involving d caudal eguina,multiple sclerosis
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9. aetiology IN FEMALE Retroverted gravid uterus Post operative
Impacted pelvic mass
Meatal stenosis
Bladder neck dyssynergia
Vesical/urethral calculi
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10. aetiology MALE CHILD Meatal ulcer with scabbing
Meatal stenosis/congenital urethral stenosis
PUV
Phimosis/paraphimosis
Neurogenic-spinal bifida
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11. precipitants alcohol Surgery CVA
Drugs eg diuretics,antticholinergics,sympathomimmeti cs,antidepressants
Painful perineal conditions

12. 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

13. 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
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14. diagnosis It depends on d age of d px Clinical findings and
Results of investigations

15. management
Resuscitation
History
o/e
Investigations Tx
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16. acute acute retention is a surgical emergency Admit the patient
RELIEVE the obstruction first
Further mgt depend on d aetiological finding
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17. 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
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18. Hx of painless haematuria
CA prostate
Patient usu >65
Weightloss
Back pain , haematuria
Bladder CA
>50 years
Hx of painless haematuria
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19. 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
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20. 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

21. Digital rectal examination
BPH
CA of prostate
Prostatitis/prostatic abscess

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

23. 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
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24. 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
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25. Correct anaemia and acidosis
Avoid rapid decompression
bleeding
postobstructive diuresis
Treat the underlying cause

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

27. Complications Bladder hypertrophy Trabeculations
Diverticular formation
Hydroureter; bilateral
Hydronephrosis
Haematuria
Renal failure
Reduced quality of life
Recc UTI
Urolithiasis
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28. 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.

29. THANKS
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