Acute urinary retention: Difference between revisions

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==Background==
==Background==
*Urologic emergency characterized by sudden inability to pass urine
*Urologic emergency characterized by sudden inability to pass urine
*Most common cause is benign prostatic hyperplasia (BPH)
*Most common cause is [[benign prostatic hyperplasia]] (BPH)
*Rare in women
*Rare in women


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==Differential Diagnosis==
==Differential Diagnosis==
{{Urinary retention DDX}}
{{Urinary retention DDX}}
{{DDX abdominal distention}}


==Evaluation==
==Evaluation==
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**Rate of decompression: rapid complete drainage  
**Rate of decompression: rapid complete drainage  
***At one time, rapid complete bladder decompression was thought to increase the rate of potential complications, however partial drainage and clamping does not reduce these complications and may increase risk for [[UTI]]<ref>Management of urinary retention: rapid versus gradual decompression and risk of complications</ref>
***At one time, rapid complete bladder decompression was thought to increase the rate of potential complications, however partial drainage and clamping does not reduce these complications and may increase risk for [[UTI]]<ref>Management of urinary retention: rapid versus gradual decompression and risk of complications</ref>
*If unable to pass Foleyconsider:
*If unable to pass Foley, consider:
**[[Coude catheter]]
**[[Coude catheter]]
**[[Suprapubic catheterization]]
**[[Suprapubic catheterization]]
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===Admission===
===Admission===
Consider for:
Consider for:
*[[Postobstructive diuresis]] >200mL/hr for 2 hours or 3L over 24 hours
*[[Post-obstructive diuresis]] >200mL/hr for 2 hours or 3L over 24 hours
*Elevated BUN/Cr ([[acute renal failure]])
*Elevated BUN/Cr ([[acute renal failure]])
*Significant [[hematuria]] or clot retention
*Significant [[hematuria]] or clot retention
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==See Also==
==See Also==
*[[Coude catheter]]
*[[Coude catheter]]
*[[Suprapubic catheter placement]]
*[[Suprapubic bladder aspiration]]
*[[Suprapubic catheter changing or replacement]]
*[[Post-obstructive diuresis]]


[[Category:Urology]]
[[Category:Urology]]

Revision as of 22:03, 9 February 2021

Background

Clinical Features

  • Suprapubic abdominal distention and/or pain
  • Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

Differential Diagnosis

Urinary retention

Abdominal distention

Evaluation

  • UA/Urine cultures
  • Chemistry
  • CBC (if suspect infection or massive hematuria)
  • Bedside ultrasound (to verify retention)
    • Incomplete retention is PVR > 50ml and > 100ml in patients > 65 years of age[1]
    • Post-void residual of 150-200 cc is particularly concerning

Management

Bladder Decompression

  • Urethral catheterization
    • Pass 14-18F Foley catheter (larger if blood clots)
    • Rate of decompression: rapid complete drainage
      • At one time, rapid complete bladder decompression was thought to increase the rate of potential complications, however partial drainage and clamping does not reduce these complications and may increase risk for UTI[2]
  • If unable to pass Foley, consider:

Other Considerations

  • Blood clot
    • Use 20-24F triple-lumen catheter to irrigate bladder until clear
  • Consider α-blocker as outpatient if concern for BPH (e.g. tamsulosin 0.4mg QHS)
    • Results in significant increase in voiding success
    • Possibility of orthostatic hypotension
  • Urology consult

Disposition

Admission

Consider for:

Discharge

  • Otherwise consider discharge with catheter placed to leg bag and urology follow up within 1 week

See Also

References

  1. Shenot PJ. Urinary Retention. Merck Manual. August 2014. http://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-retention
  2. Management of urinary retention: rapid versus gradual decompression and risk of complications