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The Management of Acute

and Chronic Retention of


Urine: ISC versus Indwelling
catheterisation.
Roisin Hart
Senior Urology Nurse Specialist
Winchester
Urinary Retention

The inability to voluntarily void urine


Categories of Urinary Retention
Obstructive
Infectious & Inflammatory
Pharmacologic
Neurologic
Other
Causes of Urinary Retention
Obstructive
Benign prostatic hyperplasia
Strictures
Bladder calculi
Faecal Impactation
Phimosis / paraphimosis
Benign/malignant pelvic masses
Meatal Stenosis
Causes of Urinary Retention
Obstructive
Organ prolapse eg: cystocele, rectrocele,
uterine prolapse
Pelvic mass gynae malignancy
Uterine fibroid / ovarian cyst
Retroverted impacted gravid uterus
Foreign bodies
Infectious and Inflammatory
Causes
Prostatitis
Prostatic abscess
Balantitis
Cystitis
Acute vulvovaginitis
Bilharziasis
Herpes simplex virus
Pharmacologic causes
Drugs with anticholingeric properties eg: tricylic
antidepressants (amitriptyline)
Opioids
Sympathomimetic drugs eg: oral decongestants
containing Ephedrine ( Sudafed)
NSAIDs in men
Antiparkinsonian agents (levodopa)
Antipsychotics (chlopromazine)
Muscle relaxants (Baclofen)
Neurologic cause
AUTONOMIC OR PERIPHERAL NERVE
Diabetes mellitus, Guillain-Barre syndrome
Pernicious anaemia, radical pelvic surgery
BRAIN
CVA, MS, Tumour, Parkinsons disease,
concussion
SPINAL CORD
Haematoma / abscess / tumour, Cauda equine,
spina bifida occulta
Other causes
Post-op complications

Pregnancy-associated retention

Trauma eg: penile fracture or laceration

Idiopathic detrusor failure


Presentation of AUR
Sudden inability to pass urine
Suprapubic pain which typically causes
spasm
Patient is acutely distressed
Often longer history of bladder outflow
symptoms
Bladder is visible,tender and palpable
Patient is typically male
Effects of AUR
Chronic Retention of Urine
Completely different maybe painless
Incomplete emptying
Often deny LUTS, nocturnal enuresis
Large bladder, ? uraemic, ?anaemic, ?
fluid overloaded
Large residual volume
May diurese
Bladder drainage may cause haematuria
Acute or chronic?
Large over distended
bladder
Pressure on kidneys
and surrounding
organs
Acute on Chronic Retention
Painful inability to
empty bladder
Previous incomplete
bladder emptying
Large volume on
catheterisation
Normal and overfilled bladder
Management of AUR
Decompression by Catheterisation
Residual Volume < 800mls
U&ES and Creatinine normal
Systemically well
Home with catheter
Follow-up plan
Management of Chronic Retention
Admit for observation including fluid balance
chart
Check renal function
Image upper tracts
Manage post obstructive diuresis
TWOC maybe unsuccessful
May need TURP but may have irreversible
detrusor failure
ISC an option or LTC
Acute or Chronic
Complications of Chronic retention
of urine
Bilateral
Hydronephrosis
Renal Inpairment
Infections
AUR
Stones
Hydronephrosis
Further Management
Varying local practices
GP/DN catheteriseTWOC at home
GP/DN catheterise refer to urology
Attend A&E catheterise send home
Attend A&E catheteriseadmitTWOC
Urethral vs. Suprapubic
catheterisation
URETHRAL SUPRAPUBIC
Usually quick & easy technical procedure
Competent staff Fewer staff
readily available competent
Infection easily Concerns over safety
introduced Easier to TWOC
Risk of Stricture Reduce risk UTI
Reduce stricture
Urethral Catheterisation
Check for sepsis prior to catheterisation
Ensure correct catheter selection
Always use an aseptic procedure
Never force catheter against resistance
Never inflate balloon in urethra
Know your limitations
Always record details and residual volume
Think Paraphimosis
Which Catheter?
Nelaton Catheters
(ISC)

Foley catheters
(Indwelling)
Complications of Indwelling
Catheter
Infection
Irritation / Erosion
Injury
Stricture and False passage
Stones / Encrustation causing blockage
Spasm / Bypassing / Expulsion
Malignant change
Haematuria
Complications of Indwelling
catheter (cont)
Insertion difficulties
Removal difficulties- non deflation
Pain or discomfort
Catheter expulsion
Infected peri-urethral glands causing
abscess/fistula
Reduced bladder capacity
Reduced mobility
Benefits of Indwelling catheter
Continence
Preserves renal
function
May reinstate social
independence
Prevents high
pressure bladder
Benefits of ISC
Lower risk of infection
Retains bladder capacity
Allows normal function
Protects renal function
Avoids encrustation
Benefits of ISC (cont)
Maintains body image
Promotes independence
Increases morale and self esteem
Reduces dependence on health
professionals
Maintains sexual function
Improves quality of life
Limitations of ISC
May not be possible in those with:
Profound physical disabilities or poor
manual dexterity.
Psychological barriers to using technique.
Small bladder capacity.
Inadequate urethral pressure.
ISC or Indwelling catheter
Not mutually exclusive

Depends on individuals needs

Patient choice