Acute Urinary Retention

Retensio urin?
• Ketidakmampuan berkemih
• Anuria, oliguria, dysuria  Tidak ada keinginan
untuk berkemih, nyeri saat berkemih
• Acute:
– Tiba tiba
– Nyeri
• Chronic:
– Sedikit tidak nyaman
– Overflow inkontinensia/ paradoks inkontinensia

Smith, General urology 18th

• Symptoms:
– Phymosis: demam
– Meatal stenosis
– Urethral stricture: history of urinary tract infection
– BPH: nocturia
– Bladder cancer: hematuria
– Neurogenic bladder: history of neurogenic disease
(stroke) or Diabetes Melitus
 Physical examination
• Pembengkakan dari
pelvis
• Kantung kemi pekak
jika diperkusi
• Retensio kronik:
kantung kemih floppy,
terlalu bunci

Blandy, lecture notes urology 6th ed

Bladder location
Anatomy
Anatomy
 Emergency !!
• Pasang kateter terlebih dahulu
 Urinary retention or anuria?
Acute Urinary Chronic Urinary Anuria (Bilateral ureteral
Retention (AUR) Retention (CUR) obstruction, single system
obstruction, renal failure)
Keinginan + - -
berkemih
Suprapubic + - -
pain and
bulging
Keadaaan good May be uremic May be uremic
Umum
Urine - Overflow -
Incontinence
Renal failure - May be + May be +
 Differential Diagnosis
• Phimosis and paraphimosis
• Meatal stenosis
• Urethra:
– Stricture
– Stone
– Stenosis (woman)
– Posterior urethral valve
– Rupture
– Tumor
– Urethritis
• Prostate:
– BPH
– Prostate cancer
– Acute prostatitis
– Prostate abscess
• Bladder:
– Stone
– Bladder neck obstruction
– Bladder cancer
– Blood Clot: cancer or trauma
• Pelvic masses
• Pelvic prolapse (woman)
• Postoperative due to: pain, limited mobility, drugs,
bladder nerve injury
• Drugs:
– Anesthetics
– Anticholinergics
– Sympathomimetics
• Neurogenic:
– Spinal cord injury
– Diabetic neuropathy
– Cauda equina lesions
– Intervertebral disc prolapse
– Neurotropic virus: herpes simplex or zoster
– Multiple sclerosis
– Transverse myelitis
– Tabes dorsalis
 Meatal Stenosis
• Pembukaan uretra (meatus eksternal) menjadi
sempit
Benign Prostate Hyperplasia
 Benign Prostate Hyperplasia
• Laki-laki, >50 yo
• Biasa terjadi pada laki laki dewasa
• Rectal Toucher: Prostat membesar, halus, tidak
ada nodul
Rectal toucher
 BPH (Treatment)
• Watchful waiting
• Medical treatment
• Surgery
– Endoscopy: Transurethral resection of Prostate
(TURP)
– Open: Open prostatectomy
 Striktur uretra
• Penyempitan lumen uretra
• Riwayat kateter, infeksi kronis, endoskopi
Anatomy
Urethral Stricture
 Treatment
• Endoscopic: internal urethrotomy
• Open: Resection Anastomosis
 Bladder Tumour
• Riwayat merokok, kerja di pabrik
• Kencing berdarah tetapi tidak sakit
• Treatment:
– Endoscopic: Transurethral resection of Bladder
tumour (TURBT)
Bladder Tumour
 Urethral and Bladder stone
• Sakit dan kencing berdarah
 Treatment
• Endoscopic: laser or stone punch
Terima Kasih