Acute urinary retention (AUR) is a urological emergency characterized by a sudden inability to void the bladder, primarily affecting men. Key risk factors include age over 70, prostate enlargement, and urinary flow issues, with common causes being benign prostatic hypertrophy and neurological impairments. Management involves bladder decompression through catheterization, with surgical options for underlying conditions and monitoring for complications.

1. ACUTE URINARY RETENTION
ANITH T V

2. DEFINITION
 AUR is the a sudden and painful inability to void the bladder.
 It’s a urological emergency.
 Commonly affects man. Men : Female ratio – 13:1


3. RISK FACTORS
 AGE – More than 70 years.
 Prostrate volume – volume greater than 30ml. (trans rectal US)
 Urinary flow rate less than 12ml/sec.
 Recurrent urinary tract infection.


4. PATHOPHYSIOLOGY
 Bladder outflow obstruction
 Neurological impairment ( affecting the motor and sensory supply of
detrusor muscle).
 Weakened bladder muscle. ( aging )
 Medications ( anticholinergic & sympathomimetic drugs )

5. ETIOLOGY
 Benign Prostatic Hypertrophy ( 53% )
 Constipation ( 7.5% )
 Urethral stricture
 Prostrate cancer ( 7% )
 Post operative ( 5% ) ( haemorrhoidectomy, fistulectomy )


6.  Neurological (spinal cord injuries, CVA, spinal cord compression,
spina bifida, general and epidural anasthesia )
 Medications / Drugs
 Genitourinary infections ( acute prostatitis, urethritis, perianal
abscess)
 Bladder stones
 Phimosis or Paraphimosis

7. CLINICAL PRESENTATION
 Inability to urinate.
 Painful urgent need to urinate.
 Pain or discomfort in the lower abdomen
 Bloating of the lower abdomen

8. DIAGNOSIS - HISTORY
 Previous history of retention
 Any surgery
 Radiation
 Pelvic trauma
 Hematuria, dysuria, fever , low back ache
 Neurological symptoms.

9. DIAGNOSIS – PHYSICAL EXAMINATION
 Lower abdominal palpation.
 Rectal examination – BPH, Fecal impaction, masses.
 Pelvic examination.
 Neurological evaluation.

10. INVESTIGATIONS
 Blood and Urine analysis
 KUB X ray
 Cystoscopy
 Ultrasound – Bladder & Prostrate, Pelvis.
 Spiral CT scan
 Post - void residual urine.
 Prostrate specific antigen

11. MANAGEMENT OF AUR
1. Bladder decompression with a Foley catheter.
(The mainstay of treatment)
Contraindication – if urethral injury is suspected.

12. 2. Emergency suprapubic puncture.
Indication – a. when catheterization failed.
b. Rupture of urethra.
Contraindication – a. CA bladder
b. Extravasation of urine.
Complications - a. Cellulitis
b. Injury to prostrate, Bowel perforation.
c. Urinary peritonitis.

13. 3. Suprapubic Cystostomy or Suprapubic Catheter.
Indications – 1. Patients with urethral stricture.
2. Pelvic trauma
3. when long term Catheterisation needed.
Contraindications – 1. CA Bladder
2. Ascites
3. Prosthetic devices (hernia mesh)

15. MANAGEMENT OF POST OPERATIVE RETENTION
 Hot water fomentation
 Provide privacy
 Make the patient stand and pass the urine
 Catheterisation

16. SURGICAL MANAGEMENT
 Definitive treatment for AUR.
 BPH – Transurethral Resection Of Prostrate. (TURP)
 Urethral Stricture – Dilation, Urethroplasty, Excision and end to end
anastomosis

17. POST OBSTRUCTIVE DIURESIS
 A physiological response to a hypervolemic state.
 Urine output > 200ml/hr for more than 2 hrs is pathological.
 Requires i.v. saline infusion & Electrolytes should be checked every
6 hrs.

18. THANK YOU