Urinary Retention
Definition
N urinary habit: Day --> q4-6h; Night --> 0-1 time
If can void 2/3 of bladder, no sx, then N
Clinical Features
Symptoms
Signs
DDx
Investigations
Bedside: Dipstick, urinalysis
Blood: UEC (renal function --> , FBC, CRP (infection), PSA not indicated yet (due catherisation)
Imaging: USS (only if renal failure, blood, UTI), multiparametric MRI (new Gold standard for prostate Ca 70% sensitivity)
Others: TRUS guided biopsy (if strong indications for prostate ca; 58% sensitivity) , transperineal prostatic biopsy (prevents urosepsis). Gleason Score min 3+3.
Management
1. Reassure
2. Pain relief - urinary catheter
3. Record residual volume
4. Admit. Watch out for infection and post obstructional diuresis (ARF: 1st function to recover is ability to concentrate urine) --> hypovolaemia --> ARF
5. Treat underlying cause
6. Trial of void
7. Do not discharge if infected, social problems
8. Alpha blockers
9. TURP - time it way after catheter removed due complication
If prostate ca positive:
1. Advice: 5% chance to have mets in 15y, 10% chance of incontinence
2 Active surveillence (3monthly PSAs, yearly biopsy)
3. Radical prostatectomy/ External beam radiotherapy, brachytherapy, cryotherapy, HIFU (75% cure rates, complications: incontinence/ impotence)
Source
Dr Stephen Brough 2014
N urinary habit: Day --> q4-6h; Night --> 0-1 time
If can void 2/3 of bladder, no sx, then N
Clinical Features
Symptoms
- Unable to pass urine
- ? bleeding/ dysuria
- ? fever
Signs
- Dull percussion of bladder
- DRE (If nodule felt in prostate: 50% chance of carcinoma)
DDx
- Bladder outlet obstruction: Prostate (BPH, prostate ca, prostatitis), urethral stricture, bladder neck stenosis, meatal stenosis, bladder/ urethral stone
- Detrusor hypocontractility
- UTI
- Constipation
- Drugs/ alcohol
- Post-operative - NOT immediate urological problem (analgesia side efx, bed rest, wounds, dehydration, general disability)
- Neurological problem
- Pregnancy
- Peritonism (appenditcitis/ diverticulitis)
Investigations
Bedside: Dipstick, urinalysis
Blood: UEC (renal function --> , FBC, CRP (infection), PSA not indicated yet (due catherisation)
Imaging: USS (only if renal failure, blood, UTI), multiparametric MRI (new Gold standard for prostate Ca 70% sensitivity)
Others: TRUS guided biopsy (if strong indications for prostate ca; 58% sensitivity) , transperineal prostatic biopsy (prevents urosepsis). Gleason Score min 3+3.
Management
1. Reassure
2. Pain relief - urinary catheter
- C/I: hx of urothelial ca/ chronic retention, blood thinners, hx of peritoneal surg (bowels in between skin and bladder)
3. Record residual volume
4. Admit. Watch out for infection and post obstructional diuresis (ARF: 1st function to recover is ability to concentrate urine) --> hypovolaemia --> ARF
5. Treat underlying cause
6. Trial of void
7. Do not discharge if infected, social problems
8. Alpha blockers
9. TURP - time it way after catheter removed due complication
If prostate ca positive:
1. Advice: 5% chance to have mets in 15y, 10% chance of incontinence
2 Active surveillence (3monthly PSAs, yearly biopsy)
3. Radical prostatectomy/ External beam radiotherapy, brachytherapy, cryotherapy, HIFU (75% cure rates, complications: incontinence/ impotence)
Source
Dr Stephen Brough 2014