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Introduction

This is the inability to micturated, and it can either be chronic or acute

 

Acute

This is a sudden inability to micturate in the presence of a painful bladder. The bladder may be slightly distended, and there will be a sensation of bladder fullness.
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 to micturate. 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.
  • Retention is particularly common in old men as a result of prostate pathology.

Causes

  • Children – congenital abnormalities
  • Young people – surgery, trauma
  • Elderly – BPH, strictures, prostatic carcinoma

Neurological

This will cause chronic retention as a result of:
  • Upper motor neurone diseases – leading to chronic retention with reflux incontinence
  • Lower motor neurone diseases – leading to chronic retention with overflow incontinence
Retention is particularly common in young adults, and requires investigation to rule out a serious underlying cause.

Differentials

Differential diagnoses will basically be any sort of UTI obstruction.
These can be divided into:

Obstructions within the lumen – this can be the lumen of the ureter, bladder, or urethra.

  • Calculus – a stone that forms in an organ or duct of the body. This may present with acute pain in the penis or glans if it is in the urethra.
  • Blood clot
  • Sloughing renal papillae (the point where the pyramid empties into the collecting ducts)
  • Tumour of renal pelvis or ureter
  • Bladder tumour
  • Congenital valves (rare) – may present in neonates, or later in life with men, and later in life in anyone with recurrent UTI’s
  • Foreign body (rare)

Obstructions in the wall of the lumen

  • BPH
  • Tumour
  • Stricture – may present with a history of trauma or serious infection. There will be gradual onset of poor stream if in urethra. Can also be caused by TB or calculus
  • Trauma
  • Congenital defects – Pelviureteric neuromuscular dysfunction, Ureterovesicual stricture

Pressure from outside

  • Tumours (colonic, retroperitoneal growths and tumours, pelvic tumours (e.g. cervical cancer)
  • Pancreatitis
  • Prostatic disease
  • Crohn’s disease
  • Phimosis
  • Diverticulitis
  • Fibroids (benign tumours that grow in the wall of the uterus)
  • Pregnancy
  • Ovarian cyst
  • Faecal impactation

Investigations

  • U+E – this will asses renal function
  • MSU – associated infection, may also detect tumour cells if requested (and if present!)
  • Cystography – visualisation of the bladder after injection of a radio-opaque substance – will show urethral valves and strictures
  • Intravenous urography – an investigation of the kidneys, ureters and bladder after injection of a radio-opaque substance – renal / bladder stones
  • Cystoscopy
  • Urodynamics – allows analysis of neurological problems and BPH.

References

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