Urinary retention resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

Urinary retention can be defined as an inability to pass urine or incomplete emptying of the bladder. It is one of the most common presenting complaint encountered in the emergency department which can be acute or chronic. It is commonly seen in males as compared to females due to benign prostate hyperplasia. If undiagnosed or left untreated, this condition can be life threatening as it may lead to kidney damage and severe urosepsis. Acute urinary retention can be extremely uncomfortable, brings the patient immediately in attention and is initially managed by urethral or suprapubic catheterization. Chronic urinary retention is often asymptomatic, not easily identified and is linked to increased post void residual volume. A complete detailed history about current prescription, over the counter and herbal medications is necessary along with focused physical examination that must include neurological evaluation.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Urinary retention in women

Urinary Retention is overall very rare in women and can be acute or chronic. Common causes include:

• Nerve injury during surgery-For example Episiotomy
• Medications-Atropine, Glycopyrrolate, Bupivacaine
• Obstructive causes-Vaginal hematoma, Vaginal packing, Sling, Foreign body, Pelvic organ prolapse, Urethral injury

Urinary Retention in Men

Urinary retention is much more common in males with male to female ratio being 13:1.

 

 

 

 

 

Causes of Acute urinary Retention in Men

❑ Obstructive causes

❑ Benign Prostate Hyperplasia

❑ Prostate or Bladder Carcinoma

❑ Constipation

❑ Urolithiasis

❑ Urethral Stricture

❑ Phimosis or Paraphimosis

❑ Infectious Causes

❑ Prostatitis-

❑ Urethritis-

❑ Genital herpes

❑ Neurological Causes

❑ stroke

❑ spinal cord injury

❑ Demyelinating disorders-Guillain barre syndrome, diabetic neuropathy, Multiple sclerosis.

❑ Detrusor Muscle Dysfunction
❑ Medications

❑ Sympathomimetic alpha adrenergic agents-Phenylephrine

❑ Sympathomimetic beta adrenergic agents-Isoproterenol

❑ Antidepressants-Amitriptyline,Imipramine

❑ Antiarrhythmics-Quinidine, procainamide, Disopyramide

❑ Anticholinergics-Atropine, oxybutynin, glycopyrrolate

❑ Antiparkinsonian agents-Amantadine, trihexyphenidyl,levadopa, bromocriptine

❑ Antipsychotics-Haloperidol, fluphenazine

❑ Hormonal agents-estrogen, progesterone, testosterone

❑ Antihistamines-diphenhydramine, hydroxysine

❑ Antihypertensives-Hydralazine,nifedipine

❑ Others-indomethacin, morphine, dopamine,amphetamines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Causes of Chronic urinary retention in Men

❑ Neurological Causes

❑ Daibetic neuropathy

❑ peripheral neuropathy

❑ Spinal injury

❑ Detrusor Muscle Dysfunction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis

A detailed history and a thorough physical examination may help in diagnosing the cause behind urinary retention.

History ❑ inquire about lower urinary symptoms ❑ how often patient has this difficulty in voiding ❑ how frequently patient void in a single day ❑ how frequently patient has weak stream of urine ❑ ask patient about difficulty holding urine ❑ ask about nocturia ❑ Does the patient have to strain or push to urinate ❑ ask about dribling after passing urine ❑ Inquire about past history of prostate disease or cancer ❑ Inquire about history of stones, STIs, radiation exposure ❑ Other symptoms ❑ hematuria ❑ Dysuria ❑ fever ❑ low back pain ❑ neurological symptoms ❑ Inquire about recent surgical procedures(patient should void in 6 hours post surgery)

Physical examination ❑ Abdominal examination ❑ Dullness above umbilicus represent 1000 ml urine ❑ dullness just below umbilicus represent about 500 ml of urine ❑ Pelvic examination/rectal examination ❑ Note for enlarged prostate or fecal impaction ❑ Genital examination ❑ poor sphincter tone suggest spinal cord problem ❑ Neurological examination ❑ strength ❑ sensation ❑ reflexes ❑ muscle tone

Evaluation ❑ collect urine sample by placing folley's catheter ❑ perform bladder ultrasound ❑ check pre and post void residual volume ❑ Complete blood count ❑ Chemistry ❑ sodium ❑ potassium ❑ bicarbonate ❑ chloride ❑ BUN and creatinine ❑ urine analysis and culture ❑ if neurological symptoms-CT head, MRI spine

Volume of urine in first 10-15 minutes of catheterization or with bladder ultrasound?

>300ml

<200 ml

❑ suggest urinary retention-keep catheter in place if >400 ml

Urinary retention unlikely

Treatment

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Do's

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Don'ts

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References

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