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Retensio Urin

Saviar Randy (12100112009)

Rizqi Kurnia Abdullah
(12100112044)

URINARY BLADDER
URETHRA
 Histologi Bladder
Epitel transisional
Lamina propria
Smooth muscle
Adventitia
Histologi Uretra
 RETENSIO URINE
is a state where a person can not
urinate (micturition) when bladder is
full but are unable to remove urine.
Urinary retention or difficulty is can
not urinate of the bladder, being
anuri cessation of urine production is
due to disturbances in the proximal
bladder
 Etiology
a. Weakness of the detrusor muscle
contractions, usually due to neurologic
abnormalities as high as sacral II - IV.
b. increase peripheral resistance may
occur in orrificium uretrae internum
until prepuce, an outline is usually
caused by:
Trauma: bladder trauma, trauma to the
urethra, penis trauma
 Infections: cystitis, prostatitis, ureteritis.
Tumors: Tumors bladder, prostate
tumors (BPH), prostate Ca, Ca penis
Congenital: Urakus, diverticular bladder,
Ekstrofia bladder, urethral stenosis
phimosis
Urinary tract stones: Vesicolitiasis,
Stone prostate, urethral stone.
 Symptom
a. Retensi urine acute condition
great discomfort
pain
hesistance
Distension of lower abdomen

b. Retensi urin chronic condition

mild discomfort
Straining
frequent of micturition
dribbling
 Mechanism
1. Bladder filled progressively
increased until the treshold at the
wall above the threshold value
2. Arise nerve reflexes (reflex
micturition) are trying to empty the
bladder or if it fails, at - least raises
awareness of the urge to urinate.
 Consequences of urinary
retention
Overstretched 1000 3000 ml urin
Decreased force of contraction
Stagnation of urine can cause infection
and can spread to the urinary system
In the early stages (phase compensation)
muscle walls become hypertrophied and
thickened bladder.
With decompensasi, kontraktile be
reduced and weak.
Changes in bladder due to
obstruction
Trabekulasi became strained
muscles and so interwoven rough
overview on the mucosal surface.
Cellules Karena hipertrofi pressure
of 3 -4 x more likely to try to remove
urine from obstruction. Consequently
pushed the superficial mucosa muscle
bundle
Mucosa If there is an acute infection
of the mucosa become red and
edema
 Complication
vesicoureteric reflux
Hidroureter
Hydronephrosis
renal failure
Hernia
Hemorrhoid
stone deposition can cause irritation
hematuria
 Epidemiology
The prevalence increases with age,
especially in males where the incidence
of BPH frequently experience (50%).
BPH in Indonesia is second only to
urinary tract stones and is expected to
be found in 50% of men aged over 50
years with a life expectancy on average
in Indonesia, which has reached 65
years
 Diagnosis
1. Anamnesis: the symptoms of obstructive and irritative
symptoms. I: frequency, urgency, disuria, nocturia. O: poor
stream, hesistence, terminal dribbling, incomplete voiding.
2. Physical examination: rectal especially on a palpable
prostatic hyperplasia enlarged prostate, chewy
consistency, flat surface, asymmetry and protruding into
the rectum. The more severe the degree of prostatic
hyperplasia upper limit of the more difficult to be touched.
3. Laboratory tests: a role in determining the presence or
absence of complications.
4. Imaging examination: In the intravenous pielografi visible
lesion contrast filling defect at the base of the bladder or
ureter distal end turned up shaped like a hook.
5. Uroflowmetry: decreases of flow urine.
Various causes of urinary
retention
1. Weakness of the bladder detrusor
Spinal cord abnormalities
neuropatia diabetes mellitus
after radical surgery in the pelvis
pharmacologic
2. Bladder neuropathy, caused by:
neurologic abnormalities
peripheral neuropathy
diabetes mellitus
alcoholism
pharmacologic (sedative, alpha
blockers and parasimpatolitik)
3. Functional obstruction:
dis-synergies detrusor-sphincter disruption of
coordination between contraction
with detrusor sphincter relaxation
detrusor instability

4. Stiffness of the neck of the bladder:

fibrosis

5. Increased urethral resistance caused by:

benign prostatic hyperplasia or malignant
abnormalities that obstruct the urethra
uretralitiasis
acute or chronic urethritis
urethral stricture

6. Acute or chronic prostatitis

 Management
Management of urinary retention
principle is:
1) Improve the general state
2) Removing the urine as soon as
possible.
3) a causal treatment.
 Urine is excreted by
Catheterization
Suprapubic puncture
cystotomy
 Causal treatment causes
urinary retention
Phimosis: by circumcision
Infection: With appropriate antibiotics
Stricture: Conservative and or operative.
Urinary tract stones: operative
Neurologic: physiotherapy
Prostate tumors:
prostate hyperplasia transurethral
resection, open prostatectomy,
cryosurgery
prostatectomy prostate carcinoma,
estrogen, orchidectomy open
 Complication
incontinence paradox
bladder stones
Hematuria
Cystitis
Pyelonephritis
vesico-ureteric reflux
Hidroureter
Hydronephrosis
renal failure
 Prognosis
Dubia, depending on what the cause
of urinary retention and the
complications that may occur. in
some cases the causative treatment
of infections such as antibiotic
therapy to treat complaints of
retention, but in the case of
malignancy prognosis can be poor.