AUR presents as the abrupt inability to pass urine.
– It is typically associated with lower abdominal and/or
suprapubic discomfort .
– Affected patients are often restless, and may appear
in considerable distress.
The patient history should focus on a previous history of
retention, surgery, radiation, or pelvic trauma.
The patient should also be asked about the presence of
hematuria , dysuria, fever, low back pain, neurologic
Finally, a complete list of prescribed and over the
counter medications should be obtained.
– Lower abdominal palpation — The urinary bladder
may be palpable, either on abdominal or rectal
– Rectal examination — A rectal examination should
be done in both men and women, to evaluate for
masses, fecal impaction, perineal sensation, and
rectal sphincter tone.
– Pelvic examination — Women with urinary retention
should have a pelvic examination.
– Neurologic evaluation
1.Bladder decompression with a Foley catheter is
the mainstay of treatment. .
– When a standard Foley catheter cannot be passed easily, sterile
2% viscous lidocaine can be injected through the urethra. This
anesthetizes and relaxes the sphincter, allowing gentle passage
– Catheterization should not be attempted when a urethral injury
– Never use force.
2 .Emergency suprapubic puncture with
• A long needle or
• A trocar & plastic tube
-when catheterization has failed
-Rapture of the urethera
-An empty bladder(if the pt has extravasation of urine
-Carcinoma of the bladder causing retention
-Injury to the prostate
3. Open suprapubic cystostomy
A , temporary
When the bladder is not sufficiently distended
Rapture of the bladder
The treatment of clot retention
As a necessary step in a urethroplasty
-If the pt has carcinoma of the bladder
B , permanent
a very tight stricture
If the pt is too ill for surgery
• Patients should be monitored for post obstructive
diuresis. This is a physiologic response to a hypervolemic
state. Occasionally, it can become a pathologic diuresis
and may warrant hospital observation, with fluid and
• Urine output greater than 200 mL/hour for more than 2
hours should be replaced with 0.5 mL of intravenous
saline for each 1 mL of urine. Electrolytes should be
checked every 6 hours initially and replaced as needed.
1. UpToDate, Word wide Clinical
2. PRIMARY SURGERY ,vol. 1
3. The Washington manual of surgery, 5th ed