Acute Urinary Retention

Definition, Risk factors, Pathophysiology, Etiology, Clinical Presentation, Diagnosis, Investigations & Management of AUR

1. ACUTE URINARY RETENTION ANITH T V

2. DEFINITION AUR is the a sudden and painful inability to void the bladder. It’s a urological emergency. Commonly affects man. Men : Female ratio – 13:1

3. RISK FACTORS AGE – More than 70 years. Prostrate volume – volume greater than 30ml. (trans rectal US) Urinary flow rate less than 12ml/sec. Recurrent urinary tract infection.

4. PATHOPHYSIOLOGY Bladder outflow obstruction Neurological impairment ( affecting the motor and sensory supply of detrusor muscle). Weakened bladder muscle. ( aging ) Medications ( anticholinergic & sympathomimetic drugs )

5. ETIOLOGY Benign Prostatic Hypertrophy ( 53% ) Constipation ( 7.5% ) Urethral stricture Prostrate cancer ( 7% ) Post operative ( 5% ) ( haemorrhoidectomy , fistulectomy )

6. Neurological (spinal cord injuries, CVA, spinal cord compression, spina bifida, general and epidural anasthesia ) Medications / Drugs Genitourinary infections ( acute prostatitis, urethritis, perianal abscess) Bladder stones Phimosis or P araphimosis

7. CLINICAL PRESENTATION Inability to urinate. Painful urgent need to urinate. Pain or discomfort in the lower abdomen Bloating of the lower abdomen

8. DIAGNOSIS - HISTORY Previous history of retention Any surgery Radiation Pelvic trauma Hematuria, dysuria, fever , low back ache Neurological symptoms.

9. DIAGNOSIS – PHYSICAL EXAMINATION Lower abdominal palpation. Rectal examination – BPH, Fecal impaction, masses. Pelvic examination. Neurological evaluation.

10. INVESTIGATIONS Blood and Urine analysis KUB X ray Cystoscopy Ultrasound – Bladder & Prostrate, Pelvis . Spiral CT scan Post - void residual urine. Prostrate specific antigen

11. MANAGEMENT OF AUR Bladder decompression with a Foley catheter. (The mainstay of treatment) Contraindication – if urethral injury is suspected.

12. Emergency suprapubic puncture . Indication – a . when catheterization failed. b . R upture of urethra. Contraindication – a. CA bladder b. Extravasation of urine. Complications - a. Cellulitis b. Injury to prostrate, Bowel perforation. c. Urinary peritonitis.

13. 3. Suprapubic Cystostomy or Suprapubic Catheter. Indications – 1. Patients with urethral stricture. 2. Pelvic trauma 3. when long term Catheterisation needed. Contraindications – 1. CA Bladder 2. Ascites 3. Prosthetic devices (hernia mesh)

14. MANAGEMENT OF POST OPERATIVE RETENTION Hot water fomentation Provide privacy Make the patient stand and pass the urine Catheterisation

15. SURGICAL MANAGEMENT Definitive treatment for AUR. BPH – Transurethral Resection Of Prostrate. (TURP) Urethral Stricture – Dilation, Urethroplasty, Excision and end to end anastomosis

16. POST OBSTRUCTIVE DIURESIS A physiological response to a hypervolemic state. Urine output > 200ml/ hr for more than 2 hrs is pathological. Requires i.v. saline infusion & Electrolytes should be checked every 6 hrs.

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