Acute urinary retention mgt

1. ACUTE URINARY RETENTION MANAGEMENT BY : Kemeria Kemal May,2010

2. INTRODUCTION    Acute urinary retention (AUR) is the most common urologic emergency. It occurs most frequently in men over age 60, and is often the result of benign prostatic hyperplasia

3. ETIOLOGY BPH Constipation Prostate cancer Urethral stricture Neurologic disorder Medications/drugs Urolithiasis Phimosis or paraphimosis, Genitourinary infections — acute prostatitis, urethritis, perianal abscess

4. CLINICAL PRESENTATION    AUR presents as the abrupt inability to pass urine. It is typically associated with lower abdominal and/or suprapubic discomfort . Affected patients are often restless, and may appear in considerable distress.

5. EVALUATION    The patient history should focus on a previous history of retention, surgery, radiation, or pelvic trauma. The patient should also be asked about the presence of hematuria , dysuria, fever, low back pain, neurologic symptoms. Finally, a complete list of prescribed and over the counter medications should be obtained.

6. physical examination Lower abdominal palpation — The urinary bladder may be palpable, either on abdominal or rectal examination. Rectal examination — A rectal examination should be done in both men and women, to evaluate for masses, fecal impaction, perineal sensation, and rectal sphincter tone. Pelvic examination — Women with urinary retention should have a pelvic examination. Neurologic evaluation

7. MANAGEMENT 1 . Bladder decompression with a Foley catheter is the mainstay of treatment. . When a standard Foley catheter cannot be passed easily, sterile 2% viscous lidocaine can be injected through the urethra. This anesthetizes and relaxes the sphincter, allowing gentle passage of catheter. Catheterization should not be attempted when a urethral injury is suspected Never use force.

8. 2 .Emergency suprapubic puncture with A long needle or A trocar & plastic tube Indication ; -when catheterization has failed - Rapture of the urethera C/I ; -An empty bladder(if the pt has extravasation of urine -Carcinoma of the bladder causing retention Cxn ; -cellulites -Injury to the prostate -Bowl Perforation -Urinary peritonitis

9. 3. Open suprapubic cystostomy A , temporary Indication When the bladder is not sufficiently distended Rapture of the bladder The treatment of clot retention As a necessary step in a urethroplasty C/I -If the pt has carcinoma of the bladder B , permanent Indication a very tight stricture If the pt is too ill for surgery

10. Patients should be monitored for post obstructive diuresis. This is a physiologic response to a hypervolemic state. Occasionally, it can become a pathologic diuresis and may warrant hospital observation, with fluid and electrolyte replacement. Urine output greater than 200 mL /hour for more than 2 hours should be replaced with 0.5 mL of intravenous saline for each 1 mL of urine. Electrolytes should be checked every 6 hours initially and replaced as needed.

11. References 1. UpToDate , Word wide Clinical Community,2008 2. PRIMARY SURGERY ,vol. 1 3. The Washington manual of surgery, 5 th ed

12. Thank you