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Acute urinary retention mgt

Acute urinary retention mgt






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    Acute urinary retention mgt Acute urinary retention mgt Presentation Transcript

    • INTRODUCTION • Acute urinary retention (AUR) is the most common urologic emergency. It occurs most frequently in men over age 60, and is often the result of benign prostatic hyperplasia
    • ETIOLOGY • • • • • • • • • BPH Constipation Prostate cancer Urethral stricture Neurologic disorder Medications/drugs Urolithiasis Phimosis or paraphimosis, Genitourinary infections — acute prostatitis, urethritis, perianal abscess
    • CLINICAL PRESENTATION – 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.
    • EVALUATION 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 symptoms. Finally, a complete list of prescribed and over the counter medications should be obtained.
    • physical examination – Lower abdominal palpation — The urinary bladder may be palpable, either on abdominal or rectal examination. – 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
    • MANAGEMENT 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 of catheter. – Catheterization should not be attempted when a urethral injury is suspected – Never use force.
    • 2 .Emergency suprapubic puncture with • A long needle or • A trocar & plastic tube Indication; -when catheterization has failed -Rapture of the urethera C/I ; -An empty bladder(if the pt has extravasation of urine -Carcinoma of the bladder causing retention Cxn; -cellulites -Injury to the prostate -Bowl Perforation -Urinary peritonitis
    • 3. Open suprapubic cystostomy A , temporary Indication     When the bladder is not sufficiently distended Rapture of the bladder The treatment of clot retention As a necessary step in a urethroplasty C/I -If the pt has carcinoma of the bladder B , permanent Indication  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 electrolyte replacement. • 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.
    • References 1. UpToDate, Word wide Clinical Community,2008 2. PRIMARY SURGERY ,vol. 1 3. The Washington manual of surgery, 5th ed