Acute urinary retention: Difference between revisions
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#CBC (if suspect infection or massive hematuria) | #CBC (if suspect infection or massive hematuria) | ||
#Bedside US (to verify retention) | #Bedside US (to verify retention) | ||
##Post-void residual of 150-200cc is abnormal | |||
== Management == | == Management == | ||
*Bladder Decompression | *Bladder Decompression |
Revision as of 23:44, 17 August 2011
Background
- Urologic emergency characterized by sudden inability to pass urine
- Most common cause is BPH
- Rare in women
Clinical Manifestations
- Lower abdominal distention / pain
- Frequency, urgency, hesitancy, dribbling, decrease in voiding stream
DDX
- Obstructive causes
- BPH
- prostate cancer
- Blood clot
- Urethral stricture
- Bladder calculi
- Bladder neoplasm
- Foreign body, urethral or bladder
- Ovarian/uterine tumor
- Neurogenic causes
- MS
- Parkinson's
- Brain tumors
- Cerebral vascular disease
- Cauda equina syndrome
- Metastatic spinal cord lesions
- Intervertebral disk herniation
- Neuropathy
- Nerve injury from pelvic surgery
- Postoperative retention
- Trauma
- Urethral injury
- Bladder injury
- Spinal cord injury
- Extraurinary causes
- Perirectal or pelvic abscesses
- Rectal or retroperitoneal masses
- Fecal impaction
- Abdominal aortic aneurysm
- Psychogenic causes
- Psychosexual stress
- Acute anxiety
- Infection
- Cystitis
- Prostatitis
- Herpes simplex (genital)
- Herpes zoster involving pelvic region
- Local abscess
- PID
- Meds
- Anticholinergics
- Antihistamines
- Cold meds
- Sympathomimetics
- TCA
- Muscle relaxants
- Narcotics
Work-Up
- UA/Ucx
- Chemistry
- CBC (if suspect infection or massive hematuria)
- Bedside US (to verify retention)
- Post-void residual of 150-200cc is abnormal
Management
- Bladder Decompression
- Urethral catheterization
- Pass 14-18F Foley catheter (larger if blood clots)
- If unable to pass Foley try Coude Catheter
- If catheterization produces gross blood remove catheter and do not attempt reinsertion
- Creation of false tract in penile soft tissue requires immediate urology consult
- Pass 14-18F Foley catheter (larger if blood clots)
- Suprapubic catheterization
- Consider if urethral catheterization fails
- US-guided results in low complication rate
- Visualize the needle in the bladder before inserting the catheter
- Urethral catheterization
- Blood clot
- Use 20-24F triple-lumen catheter to irrigate bladder until clear
- Voiding trial
- Alpha-blocker (outpt)
- Results in significant increase in voiding success
- 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
Source
Tintinalli