Urinary Retention

In this podcast Ed fleshes out your knowledge of urinary retention.

 

Lecture by

Video Duration: 12 minutes

  • Acute Urinary Retention
    Created by Dr Ed Wallitt
    General
    Epidemiology

    May be acute or chronic.

    Very common in hospital setting - particularly post-op

    Pathology

    Think it terms of obstructions, problems with the nerves and problems with the bladder muscle.

    Top three causes

    Obstructive (BPH, urethral stricture, stones), Neurological (pelvis surgery, MS) or Myogenic (e.g. over-distension of the bladder)

    Clinical Features
    Symptoms

    Lower abdominal pain and unable to pass urine

    Signs
    • Suprapubic tenderness
    • Palpable bladder (dulle to percussion and can't get beneath it)
    • Large PR on examination
    Investigations
    Cultures

    Urine dipstick and MC&S (infection)

    Bloods

    FBC, U+E, PSA (before PR!)

    Imaging

    Ultrasound - looking at bladder volume and for hypronephrosis

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Analgesia, encourage patient privacy, movement and emptying of bowels

    Medical

    Tamsulosin may reduce risk of catheterisation after retention.

    Surgical

    Catheter +/- antibiotic cover. TWOC after 2-3 days.