Acute urinary retention: Difference between revisions

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##BPH
##BPH
##prostate cancer
##prostate cancer
##Blood clot
##Urethral stricture
##Urethral stricture
##Bladder calculi
##Bladder calculi
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#Meds
#Meds
##Anticholinergics
##Anticholinergics
##Narcotics
##Antihistamines
##Cold meds
##Sympathomimetics
##Sympathomimetics
##TCA
##TCA
##Muscle relaxants
##Muscle relaxants
##Narcotics


== Work-Up ==
== Work-Up ==
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#Bedside US (to verify retention)
#Bedside US (to verify retention)


== Treatment ==
== Management ==
*Bladder Decompression
*Bladder Decompression
**Pass 14-18F Foley catheter (larger if blood clots)
**Urethral catheterization
***If unable to pass Foley catheter try [[Coude Catheter]]
***Pass 14-18F Foley catheter (larger if blood clots)
***If still unable try smaller size or perform suprapubic cath, or obtain urologic consult
****If unable to pass Foley try [[Coude Catheter]]
***If catheterization produces gross blood remove catheter and do not attempt reinsertion
****Creation of false tract in penile soft tissue requires immediate urology consult
**Suprapubic catheterization
***Consider if urethral catheterization fails
***US-guided results in low complication rate
****Visualize the needle in the bladder before inserting the catheter
*Blood clot
**Use 20-24F triple-lumen catheter to irrigate bladder until clear
*Voiding trial
*Alpha-blocker (outpt)
**Results in significant increase in voiding success
*Urology consult
**Consider for precipitated retention (stricture, prostatitis, cancer)


== Disposition ==
== Disposition ==
*Consider admission to Urology if uncontrolled pain, obstruction with infection, or inability to clear large clots
*Consider admission for:
*Pt with obstructive uropathy, go home with catheter and leg drainage bag
**Postobstructive diuresis >200cc/hr
*Follow up with Urology within 1 week
**Elevated BUN/Cr
**Clot retention
**Hematuria
**Neurologic cause
*Otherwise consider discharge w/ catheter and urology f/u in 1 week


== See Also ==
== See Also ==
[[UTI]]
*[[UTI]]
 
*[[Coude Catheter]]
[[Coude Catheter]]


[[Category:GU]]
[[Category:GU]]

Revision as of 18:48, 17 August 2011

Background

  • Urologic emergency characterized by sudden inability to pass urine
  • Most common cause is BPH
  • Rare in women

Clinical Manifestations

  • Lower abdominal distention / pain
  • Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

DDX

  1. Obstructive causes
    1. BPH
    2. prostate cancer
    3. Blood clot
    4. Urethral stricture
    5. Bladder calculi
    6. Bladder neoplasm
    7. Foreign body, urethral or bladder
    8. Ovarian/uterine tumor
  2. Neurogenic causes
    1. MS
    2. Parkinson's
    3. Brain tumors
    4. Cerebral vascular disease
    5. Cauda equina syndrome
    6. Metastatic spinal cord lesions
    7. Intervertebral disk herniation
    8. Neuropathy
    9. Nerve injury from pelvic surgery
    10. Postoperative retention
  3. Trauma
    1. Urethral injury
    2. Bladder injury
    3. Spinal cord injury
  4. Extraurinary causes
    1. Perirectal or pelvic abscesses
    2. Rectal or retroperitoneal masses
    3. Fecal impaction
    4. Abdominal aortic aneurysm
  5. Psychogenic causes
    1. Psychosexual stress
    2. Acute anxiety
  6. Infection
    1. Cystitis
    2. Prostatitis
    3. Herpes simplex (genital)
    4. Herpes zoster involving pelvic region
    5. Local abscess
    6. PID
  7. Meds
    1. Anticholinergics
    2. Antihistamines
    3. Cold meds
    4. Sympathomimetics
    5. TCA
    6. Muscle relaxants
    7. Narcotics

Work-Up

  1. UA/Ucx
  2. Chemistry
  3. CBC (if suspect infection or massive hematuria)
  4. Bedside US (to verify retention)

Management

  • Bladder Decompression
    • Urethral catheterization
      • Pass 14-18F Foley catheter (larger if blood clots)
      • If catheterization produces gross blood remove catheter and do not attempt reinsertion
        • Creation of false tract in penile soft tissue requires immediate urology consult
    • Suprapubic catheterization
      • Consider if urethral catheterization fails
      • US-guided results in low complication rate
        • Visualize the needle in the bladder before inserting the catheter
  • Blood clot
    • Use 20-24F triple-lumen catheter to irrigate bladder until clear
  • Voiding trial
  • Alpha-blocker (outpt)
    • Results in significant increase in voiding success
  • Urology consult
    • Consider for precipitated retention (stricture, prostatitis, cancer)

Disposition

  • Consider admission for:
    • Postobstructive diuresis >200cc/hr
    • Elevated BUN/Cr
    • Clot retention
    • Hematuria
    • Neurologic cause
  • Otherwise consider discharge w/ catheter and urology f/u in 1 week

See Also

Source

Tintinalli

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