Urinary Retention

Acute
(painful)

Chronic
(painless)

Lower urinary tract sx:
(irritative) FUN - frequency, urgency, nocturia
(obstructive) DISSHE - terminal dribbling, intermittent, poor stream, strain, hesitancy, incomplete empyting


Complication:

  • urinary stones (Hydronephrosis (obstructive nephropathy)
  • UTI
  • renal failure - AMS, N/V

Obstructive

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Intraluminal

urethral stricture (infection/STD/ intervention)

  • stones

blood clot
(think of obstructive nephropathy)

Intramural

Tumour of bladder neck

Urethritis

Extraluminal

BPH

prostate cancer

prostatitis

constipation

gravid uterus

UV prolapse

GI mass

Functional

Drugs (flu medicine, anticholinergics)

Neuro deficit

Peripheral nerves

spinal cord

Brain

DM neuropathy

GBS

Conus medullaris

  • trauma
  • haematoma
  • abscess

parkinson's

MS

Inx:

  • DRE for impacted stools, prostate size & consistency, anal tone
  • inguinal lymph nodes
  • bloods: FBC, inflammatory markers, renal panel, urine dipstick/UFEME/urine culture, blood culture (if septic), PSA
  • radio: U/S KUB (hydronephrosis), CT KUB, CT TAP + bone scan (prostate cancer workup)
  • special: cystoscopy (for strictures)

mx:

  • double void/pot/warm compress/K citrate/IDC (diagnostic & therapeutic)
  • analgesia
  • refer to uro for fill-and-pull/med onco/geriatrics
  • BPH - watchful waiting, alpha blocker/5a reductase inhibitors, TURP
  • neurogenic bladder - suprapubic pressure/double void, Ach agonist, intermittent IDC/sacral nerve stimulation

Dehydration

Acute mx

symptomatic, RU >300ml, NPU >6h

RU < 300ml

IDC

ambulating, BO, double voiding, pot, warm bladder compress, K citrate (10ml TDS, wait 1h)

AKI

post-op
(haemorroidectomy)

Immobility