The lecture has been given on Apr. 13th, 2011 by Dr. Ali Kamal.

2. The shock later subsides and the abdomen commences to distend

3. No desire to micturate

4. Varying degrees of abdominal rigidity and abdominal distension are present on examination

5. No suprapubic dullness, but there is tenderness

6. There may be shifting dullness

8. Intravenous urography (IVU) may confirm a leak from the bladder

9. A peritoneal ‘tap’ may be of value if facilities for radiological examination are not available

11. Hysterectomy by either the abdominal or vaginal route;

13. Urethral stricture

16. Acute urethritis or prostatitis

17. Blood clot in the bladder

18. Urethral calculus

19. Rupture of the urethra

20. Phimosis

21. Neurogenic (injury or disease of the spinal cord)

22. Smooth muscle cell dysfunction associated with ageing

23. Faecal impaction

24. Anal pain (haemorrhoidectomy)

25. Intensive postoperative analgesic treatment

27. The bladder may be visible and is tender to palpation and dull to percussion

29. These patients are at risk of upper tract dilatation because of the high intravesical tension due to the large residual urine and the high resting bladder pressure

30. Men with chronic retention owing to bladder outlet obstruction require urgent referral for prostatectomy

31. Those with a serum creatinine level greater than 200 micro-mol/litres are at risk of developing a post obstructive diuresis following catheterization and may need careful monitoring with replacement of inappropriate urine losses by intravenous saline; they are also at risk of haematuria as the previously distended urinary tract suddenly shrinks. Slow decompression by means of intermittent spigotting of the catheter does not prevent hematomaRetention with overflow<br />In this condition the patient has no control of his or her urine, small amounts passing involuntarily from time to time from a distended bladder. It may follow a neglected acute retention or chronic retention.<br />Retention with overflow is referred to also under ‘incontinence’ and ‘prostatic enlargement’. The general principles which govern the treatment of this condition are similar to those of acute retention.<br />IndwelIing catheters and closed systems of catheter drainage<br />The incidence of ascending infection following catheterisation is decreased by connecting the catheter (urethral, suprapubic or perineal) to sterile tubing connected to a sterile collecting bag and employing irrigations only if clot retention occurs. When a catheter has been in situ for 5days or more some degree of urethritis and bacteriuria is likely. Changing a catheter in the presence of active urethritis entails a risk of severe infection spreading from the anterior to the posterior urethra and thence to other parts of the urogenital system — not to mention the risk of bacteraemia, septicaemia and abscess formation elsewhere. In such patients, the change of catheter should be covered by appropriate prophylactic antibiotics.<br />Special forms of retention of urine<br />Postoperative retention of urine <br />Retention of urine can occur after any operation, but is common after operations on the anal canal and perineal region. After operations on the pelvic viscera, retention of urine is so common (sometimes owing to damage to the pelvic autonomic plexus or to nonspecific causes) that it is usual to forestall it by inserting a catheter before or at the conclusion of the operation.<br />When the patient is an elderly male, prostatic obstruction, hitherto latent, should be suspected. Many patients cannot urinate while lying or sitting in bed. In a heavily sedated patient, urinary retention may be missed and patients may suffer from severe over-distension of the bladder which can result in long-term impairment of voiding function. This is particularly common after hip replacement in elderly patients as there may be reluctance to catheterize them.<br />Treatment; First of all, reassure the patient and provide privacy. If the male patient, while supported, is permitted to sit on the edge of his bed he is often able to empty his bladder. The sound of running water is often helpful. When circumstances permit, a warm bath is often helpful. If after a reasonable trial patients cannot pass urine they must be catheterized temporarily.<br />Acute retention due to drugs<br />A number of drugs are prone to induce or precipitate retention of urine. Antihistamine drugs, antihypertensive drugs, Anticholinergic and tricyclic antidepressants may be responsible for producing acute retention of urine.<br /> <br /> <br /> <br /> <br /> <br />