DIAGNOSIS AND MANAGEMENT OF ACUTE URINARY RETENTION Gaeta N.s Urology division, department of surgery Panembahan senopati hospital

Definition Acute urinary retention (AUR) is an urological emergency characterized by a sudden and painful inability to pass urine Emberton M, Anson K. Acute urinary retention in men: an age old problem. BMJ 1999;318 : 921–5

EPIDEMIOLOGY •Overall incidence –male population –first episode AUR –2.2-8.5 events per 1000 men per year •13:1 male to female ratio •Men with LUTS –18-36 events per 1000 men per year •Age as risk factor: •70 years old –10% of men have episode of AUR •80 years old –33% of men have episode of AUR •Women –3 events per 100,000 women per year Desgrandchamps F et al: Acute urinary retention rates in the general male population and in adult men with LUTS participating in pharmacotherapy trials: A literature review. Urology 2015; 86: 654.

ANATOMY Male Anatomy Female Anatomy Gregory T. MacLennan. Hinman’s Atlas of Urosurgical Anatomy 2nd Edition. Elsevier. 2012

PATHOPHYSIOLOGY A greater resistance to the flow of urine, either related to mechanical obstruction (e.g. urethral stricture, clot retention) or dynamic obstruction (e.g. increased α –adrenergic activity) Bladder over-distension which may be secondary to the influence of drugs (e.g. anticholinergic medication inhibiting bladder contractility, opiates or opioids as a result of decreased bladder fullness) Neuropathic causes (e.g. diabetic cystopathy) Choong S, Emberton M. Acute urinary retention. BJU Int 2000;85 : 186–201

ETIOLOGY Man : Woman : Benign prostatic enlargement (BPE) due to BPH Carcinoma of the prostate Urethral stricture Prostatic abscess Woman : Pelvic prolapse (cystocoele, rectocoele, uterine) Urethral stricture; Urethral diverticulum; Post surgery for ‘stress’ incontinence Pelvic masses (e.g., ovarian masses)

MANAGEMENT The initial management of AUR consists of immediate bladder decompression with urethral or suprapubic catheterization Order specific diagnostic imaging Treat underlying disease Desgrandchamps F, De la Taille A, Doublet J. Management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia. BJU Int 2006; 97 : 727–33

SUPRAPUBIC ASPIRATION Simple procedure Act as temporary drainage Using large bore of abocath

Cystostomy Open cystostomy Close / Percutaneous cystostomy

CYSTOSTOMY COMPLICATION Hematuria Peritonitis

CYSTOSTOMY CONTRAINDICATION Patients with bladder tumor Coagulation abnormality

TWOC (Trial Without Catheter) Given alpha blocker for 3 – 5 day before catheter withdrawal Bladder training Evaluate micturition pattern after catheter withdrawal Chan PS, Wong WS, Chan LW et al. Can terazosin (alpha-blocker) relieve acute urinary retention and obviate the need for indwelling urinary catheter. Br J Urol 1996; 77 (Suppl): 7, A26

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