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Urinary Retention

Urinary retention is characterized by inability of the individual to completely empty the bladder. It can either be acute or chronic in nature.


Presentation

Individuals suffering from urinary retention have problem in emptying their bladder. They may also face difficulty in starting urination. There is a decreased ability to sense when the bladder is full. As a result, the chances of dribbling are very high. Small amounts of urine may leak when there is an increase in abdominal pressure on coughing or sneezing. Affected individuals also complain of increase in urge to urinate and have to wake up more than 3 to 4 times in the night to urinate.

Recurrent Urinary Tract Infection
  • The flow of urine from the kidneys through the efferent urinary tract can be disturbed due to constriction, flaps or malformations of the renal pelvis, ureter, bladder or urethra and lead to recurrent urinary tract infections or pressure damage to renal[asklepios.de]
  • tract infection) was 17.4% over the 4-year duration of the study. [ 11 ][patient.info]
Intermittent Fever
  • The patient was an otherwise healthy adolescent who was experiencing intermittent fevers for 1 week, and was found to be monospot positive when seen by his pediatrician.[ncbi.nlm.nih.gov]
Abdominal Pain
  • BACKGROUND: Uterine rupture classically presents with severe abdominal pain, loss of fetal station, vaginal bleeding, and shock.[ncbi.nlm.nih.gov]
  • Here we present a 16 years old girl with imperforate hymen and presented with history of lower abdominal pain and distension associated with acute urinary retention.[ncbi.nlm.nih.gov]
  • Asymptomatic urinary retention was defined as PVR   200 ml without lower urinary tract symptoms, or abdominal pain, in two consecutive measurements.[ncbi.nlm.nih.gov]
  • ., BPH, kidney stones) Urinary tract infection Signs and Symptoms of Acute Urinary Retention Acute urinary retention produces severe lower abdominal pain, a distended abdomen, and/or the sudden inability to pass urine.[healthcommunities.com]
  • Causes: In children – abdominal pain, drugs In young people – drugs, surgery, UTI , trauma, haematuria In the elderly – surgery, tumour, BPH Chronic This is the presence of a large, full painless bladder that may or may not be accompanied by the inability[almostadoctor.co.uk]
Suprapubic Pain
  • We present the case of a 30-year-old patient with multiple emergency department episodes with dysuria, urinary frequency, suprapubic pain and an episode of acute urinary retention.[ncbi.nlm.nih.gov]
  • pain (if painless and acute suspect CNS pathology) Inability to pass urine Possible bleeding Symptoms in keeping with aetiology e.g. recent dysuria, recent spinal trauma Chronic May be as above but more likely: May be asymptomatic Low flow micturition[oxfordmedicaleducation.com]
  • It may be acute (with suprapubic pain) or chronic (typically painless).[cmej.org.za]
Abdominal Distension
  • Although some patients do not present symptoms, there are frequent clinical manifestations that include: incapacity to urinate, abdominal pain, abdominal distension, palpable bladder, jactitation, urinary urgency, rigor, shiver, diaphoresis and headache[scielo.br]
Hypertension
  • The authors state the reason for this collapse is, “the overdistended bladder leads to hypertension from increased arterial wall tonus and vasoconstricution throughout the sympathetic nerve mediated vesicovascular reflex.”[rebelem.com]
  • Monitoring the patient’s blood pressure is important in patients with a history of hypertension.[neilbaum.wordpress.com]
  • Her medical history was significant for obesity, hypertension and previous salpingectomy due to ectopic pregnancy. 15 years previously a cervical cautery was performed due to cervical ectropion. On admission her vital signs were stable.[casesjournal.biomedcentral.com]
  • Lethargy, pruritus, recurrent infections, hypertension due to chronic kidney disease (rare with cases of mild-to-moderate obstructive uropathy). Signs Check blood pressure as a possible indicator of renal impairment.[patient.info]
Thrombosis
  • KEYWORDS: magnetic resonance imaging; urethral obstruction; urinary retention; venous thrombosis [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
Hyperhidrosis
  • During the patient's hospital course, he developed 3 episodes of rapid onset of profuse unilateral hyperhidrosis.[ncbi.nlm.nih.gov]
Back Pain
  • The patient should also be asked about the presence of hematuria , dysuria, fever, low back pain, neurologic symptoms.[slideshare.net]
  • The infection is acquired during sexual intercourse and presents with low back pain, penile discharge, low grade fever and an inability to pass urine.[en.wikipedia.org]
  • Urinary retention and straining are the most common urological symptoms, together with lower back pain, bilateral sciatica, saddle anaesthesia, lower limb weakness and bowel dysfunction. 6 EMG demonstrates bladder and sphincter denervation, and the diagnosis[cmej.org.za]
  • If you cannot pass urine, it can cause severe abdominal, pelvic and back pain. Many times this is an emergency situation and needs to be treated by having a urethral catheter inserted.[memorialmedical.com]
Radiculopathy
  • Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord.[ncbi.nlm.nih.gov]
  • Urinary retention may be secondary to pain or the sacral radiculopathy caused by HSV infection. 6 Clinical assessment Most patients present with obstructive as well as irritative lower urinary tract symptoms (LUTS), including weak stream, hesitancy, abdominal[cmej.org.za]
Dysautonomia
  • Focused neurological examination Looking for potential spinal lesion, MS (a rare primary presenting complaint in MS), other neurological condition that can be associated with dysautonomia e.g.[oxfordmedicaleducation.com]
Dysesthesia
  • Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord.[ncbi.nlm.nih.gov]
Clonus
  • Examination was significant for direction-changing and vertical nystagmus (direction-changing nystagmus describes a phenomenon where the fast beat changes with the direction of gaze), hyperreflexia, clonus, and Babinski and Hoffman's reflexes (all upper[ncbi.nlm.nih.gov]
Urinary Incontinence
  • Urologic manifestations of CF include infertility and azoospermia, nephrolithiasis, and stress urinary incontinence.[ncbi.nlm.nih.gov]
  • Abstract As many as 80 % of all women who complain of urine leakage will be diagnosed with stress urinary incontinence (SUI).[ncbi.nlm.nih.gov]
  • OBJECTIVE: To evaluate the relationship between perioperative use of transdermal scopolamine and the rate of urinary retention after stress urinary incontinence and pelvic organ prolapse procedures in women.[ncbi.nlm.nih.gov]
  • Algorithm 1 was unchanged; urinary incontinence and cystitis were added as exclusionary diagnoses to Algorithm 2. The PPV for the modified overall algorithm was 89.2% (74.6-97.0%).[ncbi.nlm.nih.gov]
  • When a woman experiences urinary incontinence, bowel incontinence, pelvic pain or other problems in the pelvic region, our specialists can diagnose the underlying condition through a series of testing procedures.[lluh.org]
Bladder Neck Obstruction
  • Bladder neck obstruction in females, a real entity. J Urol 1984; 132:294–298 Google Scholar 15. Axelrod SL, Blaivas JG. Bladder neck obstruction in women. J Urol 1987; 137–497 Google Scholar 16. Raz S, Smith RB.[link.springer.com]
  • Congenital deformities : Primary bladder neck obstruction, unrelated to deformities of the urethra.[patient.info]
  • neck obstruction Bladder calculi Urothelial cancer Urinary bladder tamponade Phimosis and paraphimosis Extrinsic obstruction (rare) Anterior vaginal wall prolapse Pelvic masses (e.g., benign/malignant ovarian tumor ) Rectal mass or fecal impaction Detrusor[amboss.com]
  • […] classified into mechanical/anatomical, functional/neurological, and miscellaneous causes. 4 Mechanical/anatomical causes Mechanical/anatomical causes include urethral stenosis, foreign objects, bladder stones, constipation, urethral cancer, uterine fibroids, bladder-neck[cmej.org.za]
Pelvic Pain
  • When a woman experiences urinary incontinence, bowel incontinence, pelvic pain or other problems in the pelvic region, our specialists can diagnose the underlying condition through a series of testing procedures.[lluh.org]
  • Other causes of urethral stenosis include scarring after surgery or instrumentation, or fibrosis with chronic inflammation. 7 Urinary retention is often the presenting symptom of urethral cancer. 8 Other symptoms include haematuria, pelvic pain, obstructive[cmej.org.za]
  • InterStim Therapy Interstim is a first and second phase nerve stimulation therapy for bladder disorders and pelvic pain. It is an FDA-approved procedure, which has been shown to help women with urinary retention and overactive bladder.[memorialmedical.com]
Overflow Incontinence
  • Urinary retention can be asymptomatic or cause urinary frequency, a sense of incomplete emptying, and urge or overflow incontinence. It may cause abdominal distention and pain. When retention develops slowly, pain may be absent.[msdmanuals.com]
  • Overflow incontinence is an example of chronic urinary retention , and it is often accompanied by a secondary UTI. The symptoms will be those of bladder irritation – frequency, small volume, and dysuria.[almostadoctor.co.uk]
  • Painful inability to pass urine (acute urinary retention) Chronic urinary retention associated with urinary sepsis Chronic urinary retention with renal dysfunction i.e. serum creatinine 200 mmol/l Occasionally overflow incontinence due to chronic retention[emed.ie]
  • incontinence Diabetic autonomic neuropathy Trauma (e.g., pelvic fracture , surgery/radiation of the pelvis ) Drug-induced urinary retention Due to detrusor underactivity : anticholinergics , tricyclic antidepressants , antipsychotics , calcium channel[amboss.com]
Incomplete Bladder Emptying
  • In those who can void, incomplete bladder emptying is diagnosed by postvoid catheterization or ultrasonography showing an elevated residual urine volume.[merckmanuals.com]
  • bladder emptying remifentanil Urinary retention: 0% - 1.7% retigabine Urinary retention riluzole Urinary retention: infrequent, uncommon risperidone Urinary retention: postmarketing, rare, infrequent ritonavir Urinary retention rivastigmine Urinary retention[sideeffects.embl.de]
  • This condition is characterized by urinary symptoms such as hesitancy of urination, straining to urinate, and incomplete bladder emptying.[neilbaum.wordpress.com]
  • During the Topic Refinement phase of this project, Key Informants suggested that a review focused on treatment for CUR or incomplete bladder emptying was the highest priority due to the lack of understanding about whether and how to address this condition[effectivehealthcare.ahrq.gov]

Workup

At the preliminary level, tests are employed to analyse urinary flow in order to detect the nature of abnormality that has set in. This is done through ultrasound of the bladder that reveals a slow and intermittent flow with large quantity of urine retained in the bladder after complete voiding. If the amount of urine retained after voiding is more than 50ml, then the chances of contracting urine infections is pretty high [7].

In addition, determining the serum levels of prostate specific antigen helps rule out prostate cancer. Biopsy of the prostate is also helpful in making a definite diagnosis. In addition, serum levels of creatinine and urea may be required to determine kidney damage [8].

Treatment

The following are employed for treating urinary retention:

  • Medications: Drugs such as finasteride or flomax are given to males suffering from benign prostatic hyperplasia. These medications decrease the prostate size and help in improving the urinary flow [9].
  • Catheter: Urinary catheterization is considered in cases of acute urinary retention. It also decreases the chances of urinary infection due to retention [10].
  • Surgery: This is the method of choice in those who are suffering from chronic urinary retention. In this, transurethral resection of prostate (TURP) is done in males with benign prostatic hyperplasia. It clears the bladder obstruction and thereby improves the urinary flow. However, there are various kinds of complications associated with this procedure. 
  • Voiding posture: Several studies carried out on urodynamics have suggested that males who void in the sitting position are likely to empty their bladder better than those who do it the other way. It was also revealed that in sitting position, the urinary flow increased and voiding time decreased to a significant extent.

Prognosis

Prognosis of the condition depends on the underlying etiology. If infections are the cause, then treating them helps in resolving the condition of urinary retention. Even after successful completion of treatment, chances of recurrence of urinary retention are pretty high [6]. Surgical procedures are often beneficial for correcting the underlying problem; however there are some associated risks.

Etiology

Urinary retention can occur due to some kind of obstruction that causes blockage in the pathway. These factors include cancer, kidney stones and an enlarged prostate gland [2].

Factors that favor the onset of non-obstructive urinary retention include vaginal birth, injury or trauma to the pelvic region, nerve dysfunction and accidents that cause injury to the spinal cord or brain. Urinary tract infections and various pharmacologic agents also pave way for development of urinary retention. It was studied that men who frequently succumb to non-steroidal anti-inflammatory drugs are twice more likely to develop acute urinary retention than those who do not.

Epidemiology

Elderly males are more prone to suffer from urinary retention. It is one of the most common problems of urologic emergency department. Studies have shown that about 75% males aged 70 years and above experience some form of benign prostrate hyperplasia. The incidence increases by 33% in males aged 80 years and above [3].

In young adults, the cause of urinary retention is onset of acute prostatitis. In US, about 1-3% of males aged 40 or below suffer from an attack of urinary retention due to acute prostatitis. Acute urinary tract infections, advanced stage of clinical benign prostrate hyperplasia and consequent renal failure are significantly associated with increase rate of morbidity and mortality [4].

Sex distribution
Age distribution

Pathophysiology

Urinary retention can be a result of obstructive or non-obstructive factors. Benign prostatic hyperplasia is considered to be one of the most common causes of urinary retention in men. In this condition, there is obstruction in the neck of the bladder which occurs due to prostate enlargement or constriction of prostatic urethra.

In women, urinary retention can occur either due to pelvic organ prolapse or uterine prolapse. Foreign bodies, development of stones and or urethral strictures can directly block urinary flow causing urinary retention in both men and women.

For the bladder to function normally, the interaction between the somatic nerves, brain and autonomic nervous system should work with proper coordination. Factors that interfere with this coordination can lead to urinary retention. Impaired innervation causes neurogenic bladder which is a condition common in both men and women [5].

Prevention

Some of the causes of urinary retention can be prevented to avoid its onset. For example, appropriate management of benign prostate hyperplasia by regular medications can prevent onset of urinary retention. Women are advised to strengthen the pelvic muscles through exercises if they are suffering from pelvic organ prolapse.

Summary

Urinary retention is also known as ischuria. Acute urinary retention has a sudden onset and is painful with a shorter duration. On the other hand, chronic urinary retention lasts for longer periods and is not painful. Urinary retention is often a common accompaniment of benign prostatic hyperplasia. If the condition is not timely diagnosed, it can lead to infections and in advanced stages renal failure can also occur [1].

Patient Information

Urinary retention is a condition wherein the affected individual is unable to empty his bladder. It can be either acute or chronic in nature. Various factors that cause urinary retention include development of kidney stones that block urinary flow, cancer, benign prostate hyperplasia. In addition, infections, medications and nerve dysfunction can also lead to urinary retention. Symptoms include an inability to completely empty the bladder, frequent urination, pain or discomfort in the lower abdomen, dribbling and a weak or interrupted urine flow. Treatment is by medications, insertion of catheter or in some cases, surgery.

References

Article

  1. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am 2001; 19:591.
  2. Raz S, Zeigler M, Caine M. Pharmacological receptors in the prostate. Br J Urol 1973; 45:663.
  3. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005; 173: 1256–1261.
  4. Armitage JN, Sibanda N, Cathcart PJ, Emberton M, van der Meulen JH. Mortality in men admitted to hospital with acute urinary retention: database analysis. BMJ 2007; 335: 1199–1202.
  5. Foster MC, Upsdell SM, O'Reilly PH. Urological myths. BMJ 1990; 301:1421.
  6. Cathcart P, van der Meulen J, Armitage J, Emberton M. Incidence of primary and recurrent acute urinary retention between 1998 and 2003 in England. J Urol 2006; 176: 200–204.
  7. Osius, TG, Hynman, F Jr. Dynamics of acute urinary retention: A manometric, radiographic and clinical study. J Urol 1963; 90:702.
  8. Roehrborn CG, McConnell JD, Lieber M, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999; 53:473.
  9. Bruskewitz R, Girman CJ, Fowler J, et al. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology 1999; 54:670.
  10. Oberst MT, Graham D, Geller NL, et al. Catheter management programs and postoperative urinary dysfunction. Res Nurs Health 1981; 4:175.

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Last updated: 2018-06-22 06:43