URINARY RETENTION
GROUP MEMBER :
MUHAMMAD HARIZ RAZAK
PATRICIA KOR
AINAA NADIAH ZAHARI
VINCE
SYAZWANI
DEFINITION
• Urinary retention is defined as the inability to
completely or partially empty the bladder.
• divided into acute and chronic urinary retention
• The adult urinary bladder normally holds 250 to
450 ml of urine when the micturition reflex is
triggered.
• With urinary retention, some adult bladders may
distend to hold 3000 ml of urine.
URINARY RETENTION
ACUTE RETENTION CHRONIC RETENTION
•With chronic urinary retention,enlarged
painless bladder whether or not
•sudden inability to micturate in the patient is having difficulty in
presence of painful bladder micturation and associated with
regardless of its size dribbling incontinence
• is a medical emergency requiring •may not seem life threatening, but it
prompt action can lead to serious problems and
should also receive attention from a
health professional.
male and female urinary tract
Normal physiology of urine outflow
What causes urinary retention?
1.Nerve Disease or Spinal Cord Injury
Many events or conditions can damage nerves and nerve
pathways. Some of the most common causes are
• vaginal childbirth
• infections of the brain or spinal cord
• diabetes
• stroke
• accidents that injure the brain or spinal cord
• multiple sclerosis
• heavy metal poisoning
• pelvic injury or trauma
2.Prostate Enlargement: Benign Prostatic Hyperplasia
• As a man ages, his prostate gland may enlarge. As the
prostate enlarges, the layer of tissue surrounding it stops
it from expanding, causing the gland to press against the
urethra like a clamp on a garden hose.
• As a result, the bladder wall becomes thicker and
irritable. The bladder begins to contract even when it
contains small amounts of urine, causing more frequent
urination. Eventually, the bladder weakens and loses the
ability to empty itself, so urine remains in the bladder.
3.Infection
• Infections cause swelling and irritation, or inflammation.
A urinary tract infection (UTI) may cause retention if the
urethra becomes inflamed and swells shut.
4.Surgery
• During surgery, anesthesia is often administered to block
pain signals, and fluid is given intravenously to
compensate for possible blood loss. The combination
may result in a full bladder with impaired nerve function.
Consequently, many patients have urinary retention after
surgery
5.Medication
• anti histamine (fexofenadine)
• anti cholinergic
6. Bladder stone
7.Constipation
8. Urinary stricture
Symptoms of urinary retention may include:
• Difficulty starting to urinate
• Difficulty fully emptying the bladder
• Weak dribble or stream of urine
• Loss of small amounts of urine during the day
• Inability to feel when bladder is full
• Increased abdominal pressure
• Lack of urge to urinate
• Strained efforts to push urine out of the bladder
• Frequent urination
• Nocturia (waking up more than two times at night to
urinate)
Clinical sign of urinary retention
• Discomfort in the pubic area
• Bladder distention
• Inability to void or frequent voiding of small volumes (25
to 50 ml)
• A disproportionately small amount of fluid output in
relation to intake
• Increasing restlessness and need to void
How is urinary retention
diagnosed?
1. History of complaint and physical examination
• It is important to ask about prostatic symptoms as this could give you an
indication as to whether the BPH or PrCa could be the cause of the
retention
• Ask about symptoms which might indicate a UTI as an underlying cause
such as dysuria and flank pain.
• A detailed PMHx will help indicate whether there is any likelihood of
other diseases contributing to the retention ie) any risk of cauda
equina, autonomic neuropathies (more likely to be chronic
retention), constipation, pain.
• The DHx is important as many drugs can cause urinary retention,
particularly anticholinergics and antidepressants.
• Social history helps us to elicit whether EtOH consumption or drug
abuse could have contributed to the development of retention.
In physical examination,doing a Digital Rectal Examination
is essential, as it can identify:-
• BPH (enlarged, smooth), malignant prostate (craggy,
hard) and can also help to identify other causes such as
cauda equina syndrome (reduced anal tone, saddle
anaesthesia).
INVESTIGATION
• Bloods
• FBC:- an elevated white cell count might indicate
underlying infection
• U&E’s:- important to identify if there is any kidney
damage from backpressure of urine due to the
obstruction.
• PSA:- can be unreliable in the acute setting as will
be raised by the very presence of retention as well
as after DRE. However it is useful to identify the
results from any previous PSA’s to aid in the
differential diagnosis.
• Bladder Scan
• This is done prior to catheterisation to identify the volume in
the bladder to check that the patient is in fact in retention.
• Most individuals can hold up to 600mls before becoming
significantly uncomfortable
• Chronic retainers can hold much greater volumes, often up to
1l or more.
• Urine Dip + MSU
• To identify infection and sensitivities
• cystoscopy
• x ray
• ct scan
Further investigations may include:-
– Prostate biopsy (suspicion of malignancy)
– Renal Tract US (hydronephrosis)
– MRI L-S spine (cauda equina syndrome)
– Surgery (ie TURP for BPH/PrCa)
TREATMENT
• Catheterization
• Treatment to relieve prostate enlargement
COMPLICATION OF URINARY
RETENTION
• Urinary tract infection
• Bladder damage
• Chronic kidney disease
CASE 1
