Urinary retention
Acute retention
- The bladder is usually tender containing around 600ml of urine
- In men it is usually caused by BPH precipitated by;
- Anticholinergics
- Holding on
- Constipation
- Pain
- Anaesthetics
- Alcohol
- Infection
- Examine
- Abdomen
- PR
- Perianal sensation
- Tests
- MSU, FBC, U&Es, PSA
- US
- Prevention
- Finasteride - reduces prostate size
- Tamulosin - reduces risk of need recatheterised after acute rejection
Chronic retention
- Bladder capacity may be 1.5l
- May present with;
- Overflow incontinence
- Acute on chronic retention
- Lower abdominal mass
- UTI
- Renal failure
- Causes;
- Prostatic enlargement
- Pelvic malignancy
- Rectal surgery
- DM
- CNS disease e.g. transverse myelitis/MS
- Only catheterise if there is pain, urinary infection or renal impairment
Benign prostatic hypertrophy
- Common
- Associated with;
- Frequency
- Urgency
- Voiding difficulties
- Management
- PR exam
- MSU, U&Es
- Ultrasound
- Rule out cancer - PSA, transrectal ultrasound and biopsy
- Treatment
- Watch and wait
- Transurethral resection of the prostate
- Consider peri-operative antibiotics e.g cefuroxime
- Risk of impotence
- Beware excessive bleeding post-op and clot retension
- Transurethral incision of the prostate
- Involves less destruction than the TURP and less risk to sexual function
- Best surgical option for those with small glands
- Retropubic prostatectomy
- Open operation
- Transurethral laser induced prostatectomy
- Drugs;
- ?-blockers eg. Tamsulosin, these reduce smooth muscle tone SE - drowsiness, depression, dizziness, reduced BP, dry mouth, ejaculatory failure, extra-pyramidal signs
- 5?-reducatase inhibitors e.g finasteride, these reduce testosterones conversion to dihydroxytestosterone. It is excreted in semen so warn them to use condoms and that women shouldn’t handle crushed pills. SE - impotence and reduced libido
Management of obstructive uropathy
- Insert catheter
- Get urgent US of renal tract
- Treat hyperkalaemia
- Metabolic acidosis - on ABG there is likely to be a respiratory compensated metabolic acidosis
- Post-obstructive diuresis - after relief of obstruction, kidneys can produce a lot of urine - provide resuscitation fluids to match input to output
- Sodium-bicarbonate losing nephropathy - replace with isotonic 1.26% sodium bicarbonate solution
- Infection - treat, keeping in mind that raised WCC and CRP may be due to the stress response