Acute urinary retention

Acute urinary retention is the suddenly installed inability to remove

urine from the bladder. It is a painful condition and requires the
application of emergency treatment, which often involves urethro-
bladder catheterization or cystostomy (suprapubic catheterization).
Acute urinary retention is a condition found in many medical
emergencies, with a higher frequency in men compared to women,
more common in men over the age of 70 years. Acute urinary
retention has also been recognized as a consequence of premature
urethral catheter removal in retropubic radical prostatectomies.
Causes of urinary retention
The causes of urinary retention are numerous and, depending on the
mechanism by which this retention occurs, can be obstructive,
infectious - inflammatory, neurological, drug or other causes.
• Obstructive causes
In men - benign prostatic hyperplasia, urethral meatus stenosis,
phimosis, paraphimosis, prostate cancer;
In women - cystocele, rectocele, uterine prolapse, uterine fibroids,
gynecological malignancies, ovarian cyst;
In both sexes - bladder stones, gastrointestinal or retroperitoneal
malignancies, impact with feces, bladder cancer, ureteral strictures,
the presence of foreign bodies.
• Infections and inflammation
In men - prostate, prostate abscesses, balanitis;
In women - acute vulvovaginitis, vaginal pemphigus, lichen planus
vaginal
In both sexes - biliary disease, genital herpes, varicella-zoster virus
infection, cystitis, peri-ureteral abscesses;
• Medicinal causes
- Anticholinergics - antipsychotics, antidepressants, respiratory
anticholinergics;
- Opioids and anesthetics;
- Alpha-adrenergic agonists;
- Benzodiazepines;
- Non-steroidal anti-inflammatory drugs;
- Calcium channel blockers;
- Antihistamines;
- Alcohol.
Neurological causes
- Autonomic or peripheral nerves: neuropathies, polio, pernicious
anemia, tabes, spinal injuries, diabetes, Guillain-Barre syndrome;
- Brain disorders encountered in: multiple sclerosis, cardiovascular
disease, neoplasms, Parkinson's disease, hydrocephalus;
- Diseases of the spine: disorders of the intervertebral disc, multiple
sclerosis, spina bifida, transverse myelitis, tumors, ponytail
syndrome, hematoma or intramedullary abscess, trauma to the spine,
spinal stenosis.
• Other causes
In men - penile trauma, fractures, injuries
In women - postpartum complications, dysfunction of the urethral
sphincter.
In the occurrence of acute urinary retention incriminated causes may
be: ureteral or bladder stones that have migrated and cause
obstruction along the path of urine removal from the bladder
(urethra), urinary tract infections, nervous system damage, alcohol
consumption, various allergies, consumption of various drugs
(ipratropium bromide, albuterol, epinephrine), prolonged exposure
to low temperatures, spinal disorders, complications from
anesthesia.

Symptoms encountered in acute urinary retention

In acute urinary retention the patient is unable to remove urine from
the bladder, has discomfort and hypogastric pain (lower abdomen),
presents with a bladder relaxed and firm consistency on palpation -
an aspect called globe bladder hard.
The constant accumulation of urine in the bladder determines its
relaxation, reaching, in certain situations, enormous dimensions.
This relaxation causes constant suprapubic pain, which will not
subside until the urine is removed.
Interventions in acute urinary retention
• stimulating the urine evacuation by applying warm compresses on
the pubic region, opening the valve stimulates the elimination of
urine evacuation;
• bladder evacuation survey (bladder catheterization) - not to be
traumatic and will not suddenly evacuate the contents of the bladder
- danger of bleeding. probe will be fixed = probe "to remain"; and
the patient will be transported to the hospital if the operation was
performed at home, with the thought of the urinary catheter. It also
differentiates between urinary retention and anuria.
• if the survey cannot be performed, an evacuation puncture of the
bladder will be performed - the evacuation will be done slowly, and
after performing the puncture a sterile dressing will be applied.