This document discusses urinary retention, including its types, causes, clinical features, investigations, management, and prognosis. Urinary retention is defined as the inability to void despite bladder distention. It can be acute, chronic, or acute-on-chronic. Common causes in males include benign prostatic hyperplasia and urethral stricture. Clinical features depend on whether retention is acute or chronic. Initial management involves relieving the obstruction through catheterization. Long-term management depends on identifying and treating the underlying cause. Complications can include bladder and kidney damage if not properly treated.

1. Medrockets.com

2.  Introduction
 Epidermiology
 Aetiology
 Precipitants
 Clinical features
 Investigations
 Prognosis
 conclusion
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3.  Urinary retention is said to occur when a
patient is unable to void despite d distention
of bladder with urine
TYPES
 ACUTE,
 CHRONIC,
 ACUTE-ON-CHRONIC
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4. Acute retentention-there is sudden
overdistention of d bladder associated
with severe hypogastric pain due to
ischemia of d bladder muz
Chronic retention – distention of bladder
with residual urine is gradual.it is ass
with dribbling or overflow incontinence
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5.  Is a common presentation of BOO
 About 75% of px with benign prostatic
hyperplasia in developing country present
with acute retention
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6.  ADULT MALE
1.Mechanical obstruction of the urethral
 BPH
 Urethral stricture
 Prostatic CA
 Bladder neck stenosis
 Bladder CA
 Vesical or urethral calculi
 Meatal stenosis
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7.  INFLAMMATORY
1. Acute urethritis
 Acute prostatitis
 Prostatic abscess
TRAUMATIC
 urethral rupture

8.  PREPUCE
Phimosis
Paraphimosis
NEUROGENIC
 post operative
 Spinal injury
 Spinal dx – tabes dorsalis,lesions involving d
caudal eguina,multiple sclerosis
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9.  IN FEMALE
 Retroverted gravid uterus
 Post operative
 Impacted pelvic mass
 Meatal stenosis
 Bladder neck dyssynergia
 Vesical/urethral calculi
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10.  MALE CHILD
 Meatal ulcer with scabbing
 Meatal stenosis/congenital urethral stenosis
 PUV
 Phimosis/paraphimosis
 Neurogenic-spinal bifida
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11.  alcohol
 Surgery
 CVA
 Drugs eg
diuretics,antticholinergics,sympathomimmeti
cs,antidepressants
 Painful perineal conditions

12.  ACUTE
 - sudden inability to void urine with severe
excruciating pain except in the transection
of d cord
 Suprapubic swelling
 o/e bladder is distended and tender

13.  CHRONIC
 Little or no pain
 Dribbling has been present 4 some time
 o/e – the bladder may be up to d level of d
umbilicus. Rarely may be difficult to feel d
bladder
 Most px have had symptoms of BOO - LUTS
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14.  It depends on d age of d px
 Clinical findings and
 Results of investigations

15.  Resuscitation
 History
 o/e
 Investigations
 Tx
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16.  acute retention is a surgical emergency
 Admit the patient
 RELIEVE the obstruction first
 Further mgt depend on d aetiological finding
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17.  Urethral stricture
 Px is relatively younng <45
 Past hx of urethritis
 Urethral injury
 Failure to pass catheter
 BPH
 >45
 No hx of urethritis in vast majority of px
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18.  CA prostate
 Patient usu >65
 Weightloss
 Back pain , haematuria
 Bladder CA
 >50 years
 Hx of painless haematuria
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19.  Urethritis and prostatitis
 Hx of dysuria and burning sensation in the urethral on
micturition
 Hx of urethral discharge
 Vesical or urethral calculi
 Retention occur suddenly during micturition
 There may have been freguency by day
 Terminal pain in the perineum $ tip of d penis
,strangury and haematuria
 Neurogenic bladder
hx of spinal injury
distention is painless
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20.  GPE- restless,may be in painful distress,
+/_pale ,fibrile in complicated cases
 ABDOMEN
 Suprapubic swelling with loss of crease
 Suprapubic tenderness
 On palpatn – can get above it and not below
it
 Percussion – stony dull non shifting

21.  BPH
 CA of prostate
 Prostatitis/prostatic abscess

22.  Stricture – induration at ventral aspect
 Meatal stenosis
 Phimosis- preputial opening is narrow and
the prepuce balloons during micturitn

23.  RUCG –shows stricture
 MCUG – BPH, filling defect in ca of prostate,a
dillated posterior urethral in PUV
 Abd pelvic USS –
sricture,BPH,CA,calculi,status of upper tract
 Urethroscopy-bladder CA +biopsy,calculi
 Others – PSA,urinalysis,
E U $CR
FBC
urine mcs
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24.  ACUTE- immediate relieve of obstruction by
catheterizatn maintaining strict asepsis
.suprapubic cystostostomy
-diazepam 10mg is given for sedation
-antibiotics prophlaxis gentamycin
CHRONIC -
Urgent E U CR
Catheterize
Correct fluid and electrolyte derangement
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25.  Correct anaemia and acidosis
 Avoid rapid decompression
bleeding
postobstructive diuresis
Treat the underlying cause

26. Urethrogram showing a posterior urethral
stricture secondary to sexually transmitted urethritis.

27.  Bladder hypertrophy
 Trabeculations
 Diverticular formation
 Hydroureter; bilateral
 Hydronephrosis
 Haematuria
 Renal failure
 Reduced quality of life
 Recc UTI
 Urolithiasis Medrockets.com

28.  The mgt of urinary retention depends on d
presentation-acute or chronic and the
underlying aetiology.prompt intervention is
important in preventing attending morbidity
and mortality.

29. THANKS
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