Acute urinary retention: Difference between revisions

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


*Urinary retention is the inability to void resulting in bladder distention
==Clinical Manifestations==
*Symptoms include frequency, urgency, hesitancy, dribbling, decrease in voiding stream  
*Lower abdominal distention / pain
*A sense of incomplete emptying
*Frequency, urgency, hesitancy, dribbling, decrease in voiding stream
*Most commonly affects adult men 2/2 BPH, however must exclude neurologic disease (ie Cord compression)
 
**Common causes: BPH, prostatic carcinoma, bladder carcinoma, urethral stricture, spinal cord disease or trauma, and blood clots
==DDX==
**Uncomon causes: phimosis, paraphimosis, urethritis, urethral calculus, foreign body, medications(primarily anticholinergics but also narcotics, phenothiazines, sympathomimetics, cyclic antidepressants, antihistamines, antihypertensives, and muscle relaxants)
#Obstructive causes
##BPH
##prostate cancer
##Urethral stricture
##Bladder calculi
##Bladder neoplasm
##Foreign body, urethral or bladder
##Ovarian/uterine tumor
#Neurogenic causes
##MS
##Parkinson's
##Brain tumors
##Cerebral vascular disease
##Cauda equina syndrome
##Metastatic spinal cord lesions
##Intervertebral disk herniation
##Neuropathy
##Nerve injury from pelvic surgery
##Postoperative retention
#Trauma
##Urethral injury
##Bladder injury
##Spinal cord injury
#Extraurinary causes
##Perirectal or pelvic abscesses
##Rectal or retroperitoneal masses
##Fecal impaction
##Abdominal aortic aneurysm
#Psychogenic causes
##Psychosexual stress
##Acute anxiety
#Infection
##Cystitis
##Prostatitis
##Herpes simplex (genital)
##Herpes zoster involving pelvic region
##Local abscess
##PID
#Meds
##Anticholinergics
##Narcotics
##Sympathomimetics
##TCA
##Muscle relaxants


== Work-Up ==
== Work-Up ==
*UA, UCX, CBC, Chem Panel
#UA/Ucx
*Complete GU/Rectal exam
#Chemistry
#CBC (if suspect infection or massive hematuria)
#Bedside US (to verify retention)


== Treatment ==
== Treatment ==
*Bladder Decompression
*Bladder Decompression
**Pass 16F Foley catheter(larger if large blood clots)
**Pass 14-18F Foley catheter (larger if blood clots)
**If unable to pass Foley catheter, try a 16F [[Coude Catheter]]
***If unable to pass Foley catheter try [[Coude Catheter]]
**If still unable, try a smaller size, obtain urologic consult, or perform suprapubic catherization
***If still unable try smaller size or perform suprapubic cath, or obtain urologic consult


== Disposition ==
== Disposition ==
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[[Category:GU]]
[[Category:GU]]
==Source==
Tintinalli

Revision as of 18:30, 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. Urethral stricture
    4. Bladder calculi
    5. Bladder neoplasm
    6. Foreign body, urethral or bladder
    7. 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. Narcotics
    3. Sympathomimetics
    4. TCA
    5. Muscle relaxants

Work-Up

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

Treatment

  • Bladder Decompression
    • Pass 14-18F Foley catheter (larger if blood clots)
      • If unable to pass Foley catheter try Coude Catheter
      • If still unable try smaller size or perform suprapubic cath, or obtain urologic consult

Disposition

  • Consider admission to Urology if uncontrolled pain, obstruction with infection, or inability to clear large clots
  • Pt with obstructive uropathy, go home with catheter and leg drainage bag
  • Follow up with Urology within 1 week

See Also

UTI

Coude Catheter

Source

Tintinalli

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