Acute_Retention_of_Urine_Management.pptx

Acute retension of urine

1. Management of Acute Retention of Urine Overview and Clinical Guidelines Presented by: Dr Ankur Agarwal (MS)

2. Introduction Definition: Acute retention of urine (AUR) is a sudden inability to urinate, causing a painful and distended bladder. Importance: A medical emergency that requires prompt diagnosis and management.

3. Causes of Acute Retention of Urine Mechanical Obstruction: • Benign Prostatic Hyperplasia (BPH) • Urethral strictures • Bladder stones Neurological Causes: • Spinal cord injury • Multiple sclerosis Infections and Inflammation: • Urinary tract infections (UTIs) • Prostatitis Medications: • Anticholinergics • Decongestants

4. Clinical Presentation Symptoms: • Sudden inability to urinate • Lower abdominal pain • Palpable bladder Associated Symptoms: • Frequency, urgency • Hematuria

5. Diagnosis Clinical Examination: • Bladder distension • Abdominal and rectal examination Investigations: • Ultrasound to assess bladder volume • Urinalysis • Blood tests (renal function, PSA levels)

6. Immediate Management Catheterization: • Indwelling urethral catheter (Foley catheter) • Suprapubic catheterization (if urethral catheterization fails) Pain Management: • Analgesics (e.g., NSAIDs)

7. Further Management Treatment of Underlying Cause: • BPH: Alpha-blockers, 5-alpha-reductase inhibitors • Infections: Antibiotics for UTIs • Removal of obstructing stones or strictures Monitoring: • Post-void residual urine volume • Renal function tests

8. Complications Short-term: • Bladder rupture • Acute kidney injury Long-term: • Recurrent urinary retention • Chronic kidney disease

9. Prevention and Long-Term Management Lifestyle Modifications: • Fluid management • Avoidance of medications that exacerbate urinary retention Regular Monitoring: • PSA levels • Renal function

10. Conclusion Summary: Quick intervention is critical in managing AUR to prevent complications. Final Thoughts: Early identification and treatment of the underlying cause are essential for long-term outcomes.

11. Management of Chronic Urinary Retention

12. Introduction - Chronic Urinary Retention (CUR) - Definition: Incomplete bladder emptying over a prolonged period. - Importance of effective management to prevent complications.

13. Diagnosis and Assessment - Medical History & Physical Examination - Identify underlying conditions (BPH, neurological disorders). - Diagnostic Tests - Urinary flow tests, bladder scan, cystoscopy. - Urodynamic studies for bladder function assessment.

14. Conservative Management - Lifestyle Modifications - Adjust fluid intake, avoid irritants, timed voiding. - Pelvic Floor Exercises - Strengthening muscles for better bladder control. - Intermittent Catheterization - Regular bladder emptying when self-voiding is insufficient.

15. Pharmacological Management - Alpha-blockers - E.g., Tamsulosin, Alfuzosin for muscle relaxation. - 5-Alpha-Reductase Inhibitors - E.g., Finasteride to shrink the prostate in BPH cases. - Other Medications - Anticholinergics (caution required), Cholinergic agents (rarely used).

16. Surgical Management - Prostate Surgery - TURP or laser surgery to relieve obstruction. - Urethral Procedures - Dilation or urethrotomy for strictures. - Sacral Neuromodulation - For bladder dysfunction due to neurological causes. - Urinary Diversion - Considered when bladder function cannot be restored.

17. Long-term Monitoring & Follow-up - Regular Follow-up - Monitor for complications (UTIs, bladder stones, renal impairment). - Patient Education - Symptom monitoring and importance of treatment adherence.

18. Complication Management - Infections - Consider prophylactic antibiotics for recurrent UTIs. - Kidney Function - Regular monitoring to prevent renal impairment.

19. Conclusion - Summary - Personalized treatment based on cause and patient health. - Importance of Comprehensive Management - Balancing conservative, pharmacological, and surgical approaches.