Retention of Urine Acute or Chronic

Acute Retention

Causes of Acute Retention: most frequent are Male :1-BOO 2-Urethral stricture 3-postoperative 4-Acute urethritis or prostatitis 5-phimosis Female :1-Retroverted gravid uterus 2-Multiple Sclerosis Both :1-Blood clot in the bladder 2-Urethral calculus 3-Rupture of urethra 4-Neurogenic (SCI) 5-fecal impaction

Causes (cont.) Both: 6-smooth muscle dysfunction with aging 7-faecal impaction 8-Anal pain (hemorrhoidectomy ) 9- Some drugs 10-Spinal anesthesia

Clinical Features of Acute Retention of urine No urine is passed for several hours The bladder may be visible & is tender to palpation & dull to percussion. Rarely cauda equina lesion due to prolapsed lumber disc is a cause ( check reflexes in lower limbs & perineal sensation)

Treatment In most patients the correct treatment is to pass a fine urethral catheter & to arrange further urological management occasionally post-op. Retention treated conservatively

Chronic Retention of Urine

Chronic Vs Acute The distention of the bladder is almost painless Risk of upp. Tract dilation because of high intravesical tension due to large Residual urine Painful no risk of upper tract dilation

Chronic Vs Acute Those with serum creatinin level >200 mic.mol/l are at risk of developing a post obstructive diuresis & haematuria following catheterisation so careful monitoring + replacement of inappropriate urine loss+slow decompress No increase in serum creatinin

Retention with overflow The patient has no control of his or her urine small amount of urine passing involunterily from time to time from a distended bladder it may follow neglected acute or chronic retention treatment principle similar to acute retention

Catheters

Ureteric stent jj

Indication To bypass ureteric obstruction After ureteric surgery end to end anastomosis pyeloplasty for PUJ obstruction reimplantation of ureter After uteteroscopic manipulation With ESWL in a single kidney

BLADDER INFECTIONS Uncomplicated Cystitis . Clinical Presentation dysuria, frequency or urgency, and suprapubic pain .Hematuria or foul-smelling urine may develop. Because acute cystitis, by definition, is a superficial infection of bladder mucosa, fever, chills, and other signs of dissemination are not present.

Diagnosis , a urinalysis that is positive for pyuria, bacteriuria, or hematuria, or a combination should provide sufficient documentation of UTI and a urine culture may be omitted . A urine culture should be obtained for patients i

Treatment Circumstances Route Drug Dosage (mg) Frequency per dose Duration (days) Cost per day[*] Women Healthy Oral Ciprofloxacin 500 mg BID 3 $0.50   Levofloxacin QD $5.07 TMP-SMX 1 double-strength tablet (160-800 mg) $0.26 Nitrofurantoin macrocrystals 100 mg $3.24 Norfloxacin 400 mg

Interstitial cystitis (IC) Interstitial cystitis (IC) or painful bladder syndrome (PBS), defined as “the complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency, in the absence of proven urinary infection or other obvious pathology” Female to male ratio = 5:1 Median age at onset is 40 years .

PBS/IC can be considered one of the chronic visceral pain syndromes, affecting the urogenital and rectal area, These include vulvodynia, orchialgia, penile pain, perineal pain, and rectal pain. IC is a diagnosis of exclusion , laboratory tests include urine dipstick ,urine culture in all patients. urine cytology done in risk group only Urodynamic study . Kcl PARSON TEST. Cystoscopy under general or spinal anesthesia.

Hunner ulcer glomerulations