Acute Urinary Retention

Ronald Tanggo
 History
• Inability to urinate
• Anuria, oliguria, dysuria  no desire to urinate,
suprapubic pain and bladder empty
• Acute or Chronic urinary retention?
• Acute:
– Sudden
– Painful
• Chronic:
– Little discomfort
– Overflow incontinece / Paradoxic incontinence (water
pouring over a dam)

Smith, General urology 18th

 History
• Symptoms (general):
• Lower Urinary Tract Symptoms (LUTS) – Urinary
Retention
• LUTS: storage symptoms, voiding symptoms, post
micturition symptom
• LUTS : International Prostatic Symptoms Score (IPSS)
 History
• Symptoms:
– Phymosis: fever
– Meatal stenosis: small caliber of urination
– Urethral stricture: history of urinary tract infection
– BPH: nocturia
– Bladder cancer: hematuria
– Neurogenic bladder: history of neurogenic disease
(stroke) or Diabetes Melitus
 Physical examination
• A rounded swelling
arising out of the pelvis
• The bladder is dull to
percussion
• Chronic retention:
bladder is floppy, over-
distended and not
always rise in the
midline as expected
difficult to feel.
Blandy, lecture notes urology 6th ed
Urinary retention or abdominal mass?
Bladder location
Anatomy
Anatomy
 Emergency !!
• Put catheter first without finding the causes
• Size: Male: 18 Fr, Female 16 Fr
• Use aseptic technique
Catheter Insertion
 Emergency !!
• Suprapubic punture
• Percutaneous or open cystostomy
 Urinary retention or anuria?
Acute Urinary Chronic Urinary Anuria (Bilateral ureteral
Retention (AUR) Retention (CUR) obstruction, single system
obstruction, renal failure)
Desire to + - -
urinate
Suprapubic + - -
pain and
bulging
General good May be uremic May be uremic
condition
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
Phimosis and paraphimosis
Phimosis and paraphimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Phimosis
Paraphimosis
Paraphimosis treatment
 Meatal Stenosis
• The urethral opening (external meatus)
becomes narrow
Benign Prostate Hyperplasia
 Benign Prostate Hyperplasia
• Male, >50 yo
• Common causes in male adult urinary
retention
• Rectal Toucher: Prostate size enlarged,
smooth, no nodule
Rectal toucher
 BPH (Treatment)
• Watchful waiting
• Medical treatment
• Surgery
– Endoscopy: Transurethral resection of Prostate
(TURP)
– Open: Open prostatectomy
TURP
TURP
TURP
 Urethral Stricture
• Narrowing of urethral lumen
• History of urethral catheterization, chronic
infection, endoscopic procedure
Anatomy
Urethrocystography
Urethral Stricture
 Treatment
• Endoscopic: internal urethrotomy
• Open: Resection Anastomosis
Internal urethrotomy
 Bladder Tumour
• History of cigarettes smoking, Factory worker
• Painless, intermittent gross hematuria
• Treatment:
– Endoscopic: Transurethral resection of Bladder
tumour (TURBT)
– Radical / Paliative cystectomy
Bladder Tumour
TURBT
 Urethral and Bladder stone
• Pain hematuria
• History of passing stone
 Treatment
• Endoscopic: laser or stone punch
• Open: vesicolitotomy / sectio alta
Laser lithotription
 Neurogenic Bladder
• Common: Stroke, Diabetes Mellitus, Brain
damage
Physiology of Micturition
 Take Home messages
• Urinary retention is caused by many diseases
• Each diagnosis has different symptoms and
signs
• Always remember: emergency case !!! 
INSERT catheter first
 European Association of Urology
https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/
Campbell-Walsh Urology 10th ed
Smith General Urology 17th ed
End of Presentation

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Email: ronald_tanggo@yahoo.com