Acute Urinary Retention

By:Fatimah Bassem Alshiekh 211504259

Objectives 1-Defenetion

2-Epidemiology 3-Etilogy

4-Clinical presentation5-Manegment

Acute urinary Retention

Urinary retention is the inability to empty the bladder completely. Acute urinary retention happens suddenly and lasts only a short time. People with AUR cannot urinate at all, even though they have a full bladder .

 life-threatening medical condition

EpidemiologyUrinary retention in men becomes more common with age.

1-In men 40 to 83 years old, the overall incidence of urinary retention is 4.5 to 6.8 per 1,000 men.

2-For men in their 70s, the overall incidence increases to 100 per 1,000 men.

3-For men in their 80s, the incidence of acute urinary retention is 300 per 1,000 men.

Etiology

1-Obstruction of the Urethra2-Nerve Problems

3-Medication4-Weakened Bladder Muscles

1-Obstruction of the UrethraObstruction of the urethra causes urinary retention by blocking the normal urine flow out of the body. Like in these conditions:

-Benign prostatic hyperplasia-Urethral stricture.

-Urinary tract stones.-Cystocele-Rectocele

-Constipation.-Tumors and cancers

-Benign prostatic hyperplasia

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder.

-Urethral stricture: Is a narrowing or closure of the urethra. Causes of

urethral stricture include inflammation and scar tissue from surgery, disease, recurring UTIs, or injury. prostatitis, scarring after an injury to the penis or perineum, or surgery for benign prostatic hyperplasia and prostate cancer.Urethral stricture and acute urinary retention may occur when the muscles surrounding the urethra do not relax.

-Urinary tract stones.

The stones formed or lodged in the bladder may block the opening to the urethra.

-Cystocele A cystocele is a bulging of the bladder into the

vagina. A cystocele occurs when the muscles and supportive tissues between a woman’s bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina. The abnormal position of the bladder may cause it to press against and pinch the urethra.

-RectoceleA rectocele is a bulging of the rectum into the vagina. A rectocele occurs when the muscles and supportive tissues between a woman’s rectum and vagina weaken and stretch, letting the rectum sag from its normal position and bulge into the vagina. The abnormal position of the rectum may cause it to press against and pinch the urethra.

-Constipation.Some people with constipation often have to strain to have a bowel movement. Hard stools in the rectum may push against the bladder and urethra, causing the urethra to be pinched, especially if a rectocele is present.

-Tumors and cancersTumors and cancerous tissues in the bladder or urethra can gradually expand and obstruct urine flow by pressing against and pinching the urethra or by blocking the bladder outlet.

2-Nerve ProblemsSome of the most common causes of nerve problems include:

-vaginal childbirth-brain or spinal cord infections or injuries

-diabetes--stroke

-multiple sclerosis-pelvic injury or trauma-heavy metal poisoning

-children are born with defects that affect the coordination of nerve signals among the bladder, spinal cord, and brain.

-Spina bifida and other birth defects that affect the spinal cord can lead to urinary retention in newborns.

-bladder distention during general anesthesia, or epidural analgesia without an indwelling Foley catheter.

3-MedicationVarious classes of medications can cause urinary retention by interfering with nerve signals to the bladder and prostate. These medications includeAntihistamines, anticholinergics , antispasmodics , tricyclic antidepressants.

4-Weakened Bladder MusclesAging is a common cause of weakened bladder muscles. Weakened bladder muscles may not contract strongly enough or long enough to empty the bladder completely, resulting in urinary retention.

Clinical presentation

-inability to urinate. -painful urgent need to urinate.

-pain or discomfort in the lower abdomen.-bloating of the lower abdomen.

Evaluation by: 1-The patient history should focus on a

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

2-The physical examination should include the following:

●Lower abdominal palpation — The urinary bladder may be palpable, either on abdominal or rectal examination. Deep suprapubic palpation will provoke discomfort.

●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. A normal prostate examination does not preclude BPH as a cause of obstruction.

●Pelvic examination — Women with urinary retention should have a pelvic examination.

●Neurologic evaluation — The neurologic examination should include assessment of strength, sensation, reflexes, and muscle tone.

Initial management :prompt bladder decompression. This can be accomplished with urethral or suprapubic catheterization. Patients who have had recent urologic surgery (eg, radical prostatectomy or urethral reconstruction) and develop acute retention should not have urethral catheterization; an initial attempt at urethral catheterization is appropriate for most other patients. We generally have patients return in one to two weeks.

Management

SURGICAL THERAPY: Surgical therapy remains the definitive treatment of AUR. Among symptomatic patients with BPH, transurethral resection of the prostate.

Summary: -Acute urinary retention (AUR) is the most common

urologic emergency, affecting 1 in 10 men age 70 and older .

-Benign prostate hyperplasia (BPH) is the most common underlying condition, but multiple etiologies may cause AUR .

-Initial management of AUR involves prompt bladder decompression.

REFERENCES:1-http://www.uptodate.com

2-National Kidney and Urologic DiseasesInformation Clearinghouse

Any Questions

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