Contents
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.
