Renal, Urinary and Bladder > Urinary Retention > Flashcards

Urinary Retention Flashcards

(24 cards)

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1
Q

Clinical features of urinary retention?

A
  • Suprapubic pain
  • Abdo: Palpable / percussible bladder
  • Genitalia: phimosis / balanitis / meatal stenosis / epididymitis / Possible purulent or bloody meatal d/c
  • DRE: CaP? Reduced anal sphincter tone? BPH?
  • If neurological: altered reflexes, reduced anal wink, saddle anaesthesia
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2
Q

Ix in urinary retention?

A
  • UEC and Cr
  • MSU urine for MCS
  • ?PSA
  • ?Cystoscopy
  • Bladder scan w/ PVR
  • RT U/S hydronephrosis, residual volume
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3
Q

Mx acute urinary retention?

A
  • Treat underlying cause
  • Catheterise: leave Foley to drain bladder; r/v to determine cause
  • Closely monitor fluid status and electrolytes
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4
Q

Mx chronic urinary retention?

A

Intermittent catheterisation by patient commonly used; definite treatment depends on aetiology

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5
Q

Mx of post op pts with urinary retention?

A
  • encourage ambulation
  • a-blockers to relax bladder neck outlet
  • may need catheterisation
  • definitive treatment will depend on aetiology
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6
Q

Which pts may have falsely elevated PVR measure on bladder scan?

A

Pts with ascites

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7
Q

Contrast acute and chronic retention?

A

Acute retention is a medical emergency characterised by PAIN and anuria with normal bladder volume and architecture. Acute over distention can lead to bladder rupture.
Chronic retention can be asymptomatic with greatly increased bladder volume and detrusor hypertrophy followed by atony (late)

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8
Q

Broad aetiology of urinary retention?

A
  • Outflow obstruction
  • Bladder innervation
  • Pharmacologic
  • Infection
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9
Q

Causes of outflow obstruction precipitating urinary retention?

A
  • Bladder neck or urethra: calculus, clot, foreign body, neoplasm, neurological
  • Prostate: BPH, prostate cancer
  • Urethra: stricture, phimosis, traumatic disruption
  • Miscellaneous: constipation, pelvic mass.
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10
Q

Causes of urinary retention resulting from change to bladder innervation?

A
  • Intracranial: CVA, tumour, Parkinson’s, cerebral pasly
  • Spinal cord: injury, disc herniation, MS
  • DM
  • Post abdo or pelvic surgery
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11
Q

Drugs precipitating urinary retention?

A
  • Anticholinergics
  • Narcotics
  • Antihypertensives (ganglionic blockers)
  • OTC cold medications containing ephedrine or pseudo ephedrine
  • Antihistamines
  • Psychosomatic substances (e.g. ecstasy)
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12
Q

Infections causing urinary retention?

A
  • GU: UTI, prostatitis, abscess, genital herpes
  • Infected foreign body
  • Varicella zoster
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13
Q

Irritative LUTS?

A

IFUND

  • Incontinence
  • Frequency
  • Urgency
  • Nocturia
  • Dysuria
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14
Q

Obstructive LUTS?

A

SHED

  • Straining
  • Hesitancy
  • Incomplete emptying
  • Terminal dribbling
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15
Q

Ix in obstructive LUTS?

A
  • MSU
  • UEC and Cr
  • ?PSA
  • Bladder diary
  • Voiding flow rate
  • US: PRV and hydronephrosis
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16
Q

Rx obstructive LUTS?

Study These Flashcards
A
  • Observe
  • Medical:
  • -> alpha blockers
  • -> 5a reductase inhibitors
  • Surgical:
  • -> TURP
  • -> BNI
  • -> Open prostatectomy
17
Q

What are the acute precipitants of acute urinary retention?

Study These Flashcards
A
  • UTI
  • Diuresis
  • Constipation
  • Drugs
  • Post op
  • Bleeding (clot retention)
18
Q

RFx for acute urinary retention?

Study These Flashcards
A
  • Aging
  • Established LUTS
  • Low urinary flow rate
  • Enlarged prostate
  • Raised PSA
19
Q

Causes of female acute urinary retention?

Study These Flashcards
A
  • REFLEX: urethritis / UTI
  • INTRINSIC COMPRESSION: meatal stenosis / stricture, tumour, urethral diverticulum / stone
  • EXTRENSIC COMPRESSION: severe prolapse, pelvic space occupying lesion
20
Q

Initial management in pt w/ AUR?

Study These Flashcards
A
  • Brief history
  • Anything complicating catheterisation (PHx TURP, strictures)
  • Pass catheter
21
Q

Catheter sizes for man, woman and 3-way haematuria?

Study These Flashcards
A
  • Man: 12-14F
  • Woman: 14-16F
  • 3 way for haematuria: 22-24F
22
Q

What is obstructive nephropathy?

Study These Flashcards
A

-back pressure from AUR
-renal dysfunction
Defined by elevated Cr and B/L hydronephrosis

23
Q

Mx obstructive neprhopathy?

Study These Flashcards
A
  • Admit
  • Monitor urine hourly
  • Replace urine output w/ 1/2 volume 0.9% NaCl
  • Regular UEC
  • Replace Mg2+ / PO43- as required
24
Q

Considerations when commencing pt w/ self catheter?

Study These Flashcards
A
  • Leg bag education (day and night bags)
  • Ensure right length of tubing for pt
  • Anchor catheter (prevent erosion through urethral meatus –> hypospadias)
  • Consider tamsulosin 0.4mg OD
  • Consider admission if safety issue
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