Acute Urinary Retention

Ronald Tanggo
 Urology Textbooks
https://uroweb.org/guidelines/ Campbell Walsh Urology 11th ed
Smith and Tanagho's General Urology 18th ed
 History
Inability to urinate
Anuria, oliguria, dysuria no desire to urinate,
suprapubic pain and bladder empty
Acute or Chronic urinary retention?
Acute:
Sudden
Painful
Chronic:
Little discomfort
Overflow incontinece / Paradoxic incontinence (water
pouring over a dam)

Smith, General urology 18th

 History
Symptoms (general):
Lower Urinary Tract Symptoms (LUTS) Urinary
Retention
LUTS: storage symptoms, voiding symptoms, post
micturition symptom
LUTS : International Prostatic Symptoms Score (IPSS)
 History
Symptoms:
Phymosis: fever
Meatal stenosis: small caliber of urination
Urethral stricture: history of urinary tract infection
BPH: nocturia
Bladder cancer: hematuria
Neurogenic bladder: history of neurogenic disease
(stroke) or Diabetes Melitus
 Physical examination
A rounded swelling
arising out of the pelvis
The bladder is dull to
percussion
Chronic retention:
bladder is floppy, over-
distended and not
always rise in the
midline as expected
difficult to feel.
Blandy, lecture notes urology 6th ed
Urinary retention or abdominal mass?
Bladder location
Anatomy
Anatomy
 Emergency !!
Put catheter first without finding the causes
Size: Male: 18 Fr, Female 16 Fr
Use aseptic technique
Catheter Insertion
 Emergency !!
Suprapubic punture
Percutaneous or open cystostomy
 Urinary retention or anuria?
Acute Urinary Chronic Urinary Anuria (Bilateral ureteral
Retention (AUR) Retention (CUR) obstruction, single system
obstruction, renal failure)
Desire to + - -
urinate
Suprapubic + - -
pain and
bulging
General good May be uremic May be uremic
condition
Urine - Overflow -
Incontinence
Renal failure - May be + May be +
 Differential Diagnosis
Phimosis and paraphimosis Postoperative due to: pain, limited mobility, drugs,
Meatal stenosis bladder nerve injury
Urethra: Drugs:
Stricture Anesthetics
Stone Anticholinergics
Stenosis (woman) Sympathomimetics
Posterior urethral valve Neurogenic:
Rupture Spinal cord injury
Tumor Diabetic neuropathy
Urethritis Cauda equina lesions
Prostate: Intervertebral disc prolapse
BPH Neurotropic virus: herpes simplex or zoster
Prostate cancer Multiple sclerosis
Acute prostatitis
Transverse myelitis
Prostate abscess
Tabes dorsalis
Bladder:
Stone
Bladder neck obstruction
Bladder cancer
Blood Clot: cancer or trauma
Pelvic masses
Pelvic prolapse (woman)
 Phimosis and paraphimosis

Phimosis: young boy, fever,

skin swelling
Paraphmiosis: iatrogenic
Phimosis and paraphimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Paraphimosis
Paraphimosis treatment
 Meatal Stenosis
The urethral opening (external meatus)
becomes narrow
Small caliber urine stream
Benign Prostate Hyperplasia
 Benign Prostate Hyperplasia
Male, >50 yo
Common causes in male adult urinary
retention
Rectal Toucher: Prostate size enlarged,
smooth, no nodule
Rectal toucher
 BPH (Treatment)
Watchful waiting
Medical treatment
Surgery
Endoscopy: Transurethral resection of Prostate
(TURP)
Open: Open prostatectomy
TURP
TURP
TURP
 Urethral Stricture
Narrowing of urethral lumen
History of urethral catheterization, chronic
infection, endoscopic procedure
Weak urine stream
Anatomy
Urethrocystography
Urethral Stricture
 Treatment
Endoscopic: internal urethrotomy
Open: Resection Anastomosis
Internal urethrotomy
 Bladder Tumour
History of cigarettes smoking, Factory worker
Painless, intermittent gross hematuria
Treatment:
Endoscopic: Transurethral resection of Bladder
tumour (TURBT)
Radical / Paliative cystectomy
Bladder Tumour
TURBT
 Urethral and Bladder stone
Pain hematuria
History of passing stone
 Treatment
Endoscopic: laser or stone punch
Open: vesicolitotomy / sectio alta
Laser lithotription
 Neurogenic Bladder
Common: Stroke, Diabetes Mellitus, Brain
damage
Physiology of Micturition
 Take Home messages
Urinary retention is caused by many diseases
Each diagnosis has different symptoms and
signs
Always remember: emergency case !!!
INSERT catheter first
 Thank You

Ronald_tanggo@yahoo.com
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