1. Retention of Urine
Acute or Chronic

2. Acute Retention

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

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

5. 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)

6. 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

7. Chronic Retention of Urine

8. 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

9. 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

10. 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

12. Catheters

13. Ureteric stent jj

14. 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

15. 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.

16. 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

17. 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 ( mg)
$0.26
Nitrofurantoin macrocrystals
100 mg
$3.24
Norfloxacin
400 mg

18. 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 .

19. 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.

20. Hunner ulcer glomerulations