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Acute urinary retention

Overview
  • Definition: A sudden inability to pass urine despite a full bladder, often associated with lower abdominal pain.
Aetiology/ Risk Factors
  • Prostatic: Benign prostatic hyperplasia (BPH), prostate cancer.
  • Bladder outlet obstruction: e.g., urethral stricture.
  • Medications: Anticholinergics, sympathomimetics, opioids, antipsychotics.
  • Neurological causes: Multiple sclerosis, spinal cord injury, cauda equina syndrome.
  • Post-operative: Especially after pelvic or abdominal surgery.
  • Trauma: Pelvic fractures.
  • Infection: e.g., acute prostatitis.
Clinical Features
  • Unable to pass urine.
  • Distended, palpable, and tender bladder.
  • Lower abdominal pain.
  • Overflow incontinence may occur.
Investigations
  • Bladder scan/ultrasound: To confirm retention and measure residual volume.
  • Urine dipstick: To check for infection, haematuria.
  • Blood tests: Urea and electrolytes, prostate-specific antigen (PSA).
  • Cystoscopy: For visual assessment of the bladder and prostate.
Management
  • Immediate: Catheterisation ā€“ usually with a Foley catheter.
  • Identify and treat the underlying cause: e.g., alpha-blockers for BPH.
  • Analgesia: Paracetamol, NSAIDs.
  • Antibiotics: If concurrent UTI is suspected.
  • Twoc (Trial without catheter): Once the cause has been treated, to see if the patient can void spontaneously.
Complications
  • Urinary tract infection (UTI) due to catheterisation.
  • Bladder damage.
  • Chronic urinary retention.
Key Points
  • Acute urinary retention is a medical emergency.
  • Always assess for possible underlying causes, including medications.
  • Immediate management involves bladder decompression with catheterisation.

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