Acute urinary retention: Difference between revisions
Line 19: Line 19:
##Ovarian/uterine tumor
##Ovarian/uterine tumor
#Neurogenic causes
#Neurogenic causes
##MS
##[[Multiple sclerosis]]
##Parkinson's
##Parkinson's
##Brain tumors
##Brain tumors
##Cerebral vascular disease
##Cerebral vascular disease
##Cauda equina syndrome
##[[Cauda equina syndrome]]
##Metastatic spinal cord lesions
##Metastatic spinal cord lesions
##Intervertebral disk herniation
##Intervertebral disk herniation
Line 32: Line 32:
##Urethral injury
##Urethral injury
##Bladder injury
##Bladder injury
##Spinal cord injury
##[[Spinal cord injury]]
#Extraurinary causes
#Extraurinary causes
##Perirectal or pelvic abscesses
##Perirectal or pelvic abscesses
Line 44: Line 44:
##[[Cystitis]]
##[[Cystitis]]
##[[Prostatitis]]
##[[Prostatitis]]
##Herpes Simplex (genital)
##[[Herpes Simplex]] (genital)
##[[Herpes Zoster]] involving pelvic region
##[[Herpes Zoster]] involving pelvic region
##Local [[Abscess]]
##Local [[Abscess]]
##[[PID]]
##[[PID]]
#Meds
#Meds
##Anticholinergics
##[[Anticholinergics]]
##Antihistamines
##[[Antihistamines]]
##Cold meds
##Cold meds
##Sympathomimetics
##Sympathomimetics
##[[TCA]]
##[[TCA]]
##Muscle relaxants
##Muscle relaxants
##Narcotics
##[[Opioids]]


==Work-Up==
==Work-Up==

Revision as of 23:13, 13 July 2016

Background

  • Urologic emergency characterized by sudden inability to pass urine
  • Most common cause is benign prostatic hyperplasia (BPH)
  • Rare in women

Clinical Manifestations

  • Lower abdominal distention / pain
  • Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

DDX

  1. Obstructive causes
    1. BPH
    2. Prostate cancer
    3. Blood clot
    4. Urethral Stricture
    5. Bladder Calculi
    6. Bladder neoplasm
    7. Foreign body, urethral or bladder
    8. Ovarian/uterine tumor
  2. Neurogenic causes
    1. Multiple sclerosis
    2. Parkinson's
    3. Brain tumors
    4. Cerebral vascular disease
    5. Cauda equina syndrome
    6. Metastatic spinal cord lesions
    7. Intervertebral disk herniation
    8. Neuropathy
    9. Nerve injury from pelvic surgery
    10. Postoperative retention
  3. Trauma
    1. Urethral injury
    2. Bladder injury
    3. Spinal cord injury
  4. Extraurinary causes
    1. Perirectal or pelvic abscesses
    2. Rectal or retroperitoneal masses
    3. Fecal impaction
    4. Abdominal Aortic Aneurysm
  5. Psychogenic causes
    1. Psychosexual stress
    2. Acute anxiety
  6. Infection
    1. Cystitis
    2. Prostatitis
    3. Herpes Simplex (genital)
    4. Herpes Zoster involving pelvic region
    5. Local Abscess
    6. PID
  7. Meds
    1. Anticholinergics
    2. Antihistamines
    3. Cold meds
    4. Sympathomimetics
    5. TCA
    6. Muscle relaxants
    7. Opioids

Work-Up

  1. UA/Urine cultures
  2. Chemistry
  3. CBC (if suspect infection or massive hematuria)
  4. Bedside US (to verify retention)
    1. Incomplete retention is PVR > 50 ml and > 100 ml in patients > 65 yoa[1]
    2. Post-void residual of 150-200 cc is particularly concerning

Management

  • Bladder Decompression
    • Urethral catheterization
      • Pass 14-18F Foley catheter (larger if blood clots)
      • If catheterization produces gross blood remove catheter and do not attempt reinsertion
        • Creation of false tract in penile soft tissue requires immediate urology consult
    • Suprapubic catheterization
      • Consider if urethral catheterization fails
      • US-guided results in low complication rate
        • Visualize the needle in the bladder before inserting the catheter
  • Blood clot
    • Use 20-24F triple-lumen catheter to irrigate bladder until clear
  • Voiding trial
  • Alpha-blocker (outpt) - Tamslosin 0.4mg qday
    • Results in significant increase in voiding success
    • Possibility of hypotension with med use
  • Bladder spasm
    • Oxybutinin 2.5mg TID
      • Note: Anticholinergic so can cause urinary retention
  • Urology consult
    • Consider for precipitated retention (stricture, prostatitis, cancer)

Disposition

  • Consider admission for:
    • Postobstructive diuresis >200cc/hr
    • Elevated BUN/Cr
    • Clot retention
    • Hematuria
    • Neurologic cause
  • Otherwise consider discharge w/ catheter and urology f/u in 1 week

See Also

References

  1. ↑ Shenot PJ. Urinary Retention. Merck Manual. August 2014. http://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-retention


Retrieved from "https://www.wikem.org/w/index.php?title=Acute_urinary_retention&oldid=85102"