Urinary retention is the inability to empty the bladder completely. It can happen suddenly and be acute or last a short time, or it can be chronic. The main causes are obstruction of the urethra from conditions like enlarged prostate, strictures, or tumors, nerve problems from issues like diabetes or injury, certain medications, or weakened bladder muscles from aging. Men over 70 are most at risk. Evaluation involves history, exam, and bladder drainage initially via catheter. Long term treatment depends on the underlying cause but may involve surgery.

1. By:Fatimah Bassem Alshiekh
211504259

2. 1-Defenetion
2-Epidemiology
3-Etilogy
4-Clinical presentation
5-Manegment

3. Urinary retention is the inability to empty
the bladder completely. Acute urinary
retention happens suddenly and lasts only a
short time. People with AUR cannot urinate
at all, even though they have a full bladder.
life-threatening medical condition

4. Urinary retention in men becomes
more common with age.
1-In men 40 to 83 years old, the
overall incidence of urinary
retention is 4.5 to 6.8 per 1,000
men.
2-For men in their 70s, the overall
incidence increases to 100 per
1,000 men.
3-For men in their 80s, the
incidence of acute urinary retention
is 300 per 1,000 men.

5. 1-Obstruction of the Urethra
2-Nerve Problems
3-Medication
4-Weakened Bladder Muscles

6. 1-Obstruction of the Urethra
Obstruction of the urethra causes urinary
retention by blocking the normal urine flow
out of the body. Like in these conditions :
-Benign prostatic hyperplasia
-Urethral stricture.
-Urinary tract stones.
-Cystocele
-Rectocele
-Constipation.
-Tumors and cancers

7. -Benign prostatic hyperplasia
As the prostate enlarges, the gland presses
against and pinches the urethra. The bladder
wall becomes thicker. Eventually, the bladder
may weaken and lose the ability to empty
completely, leaving some urine in the bladder.

8. -Urethral stricture:
Is a narrowing or closure of the urethra. Causes of
urethral stricture include inflammation and scar tissue
from surgery, disease, recurring UTIs, or injury.
prostatitis, scarring after an injury to the penis or
perineum, or surgery for benign prostatic hyperplasia
and prostate cancer.
Urethral stricture and acute urinary retention may occur
when the muscles surrounding the urethra do not relax.

9. -Urinary tract stones.
The stones formed or lodged
in the bladder may block the
opening to the urethra.

10. -Cystocele
A cystocele is a bulging of the bladder into
the vagina. A cystocele occurs when the
muscles and supportive tissues between a
woman’s bladder and vagina weaken and
stretch, letting the bladder sag from its
normal position and bulge into the vagina. The
abnormal position of the bladder may cause it
to press against and pinch the urethra.

11. -Rectocele
A rectocele is a bulging of the rectum into the vagina. A
rectocele occurs when the muscles and supportive tissues
between a woman’s rectum and vagina weaken and
stretch, letting the rectum sag from its normal position and
bulge into the vagina. The abnormal position of the rectum
may cause it to press against and pinch the urethra.

12. -Constipation.
Some people with constipation often have to
strain to have a bowel movement. Hard stools in
the rectum may push against the bladder and
urethra, causing the urethra to be pinched,
especially if a rectocele is present.

13. -Tumors and cancers
Tumors and cancerous tissues in the bladder or
urethra can gradually expand and obstruct urine
flow by pressing against and pinching the urethra
or by blocking the bladder outlet.

14. 2-Nerve Problems
Some of the most common causes of nerve problems include:
-vaginal childbirth
-brain or spinal cord infections or injuries
-diabetes-
-stroke
-multiple sclerosis
-pelvic injury or trauma
-heavy metal poisoning
-children are born with defects that affect the coordination of nerve
signals among the bladder, spinal cord, and brain.
- Spina bifida and other birth defects that affect the spinal cord can
lead to urinary retention in newborns.
-bladder distention during general anesthesia, or epidural analgesia
without an indwelling Foley catheter.

15. 3-Medication
Various classes of medications can cause urinary
retention by interfering with nerve signals to the
bladder and prostate. These medications include
Antihistamines, anticholinergics , antispasmodics ,
tricyclic antidepressants.

16. 4-Weakened Bladder Muscles
Aging is a common cause of weakened bladder
muscles. Weakened bladder muscles may not
contract strongly enough or long enough to empty
the bladder completely, resulting in urinary
retention.

17. -inability to urinate .
-painful urgent need to urinate .
-pain or discomfort in the lower abdomen.
-bloating of the lower abdomen.

18. Evaluation by :
1-The patient history should focus on a
previous history of retention, prostate
cancer, surgery, radiation, or pelvic
trauma. The patient should also be asked
about the presence of hematuria, dysuria,
fever, low back pain, neurologic
symptoms, or rash. Finally, a complete
list of prescribed and over the counter
medications should be obtained.

19. 2-The physical examination should include the
following:
●Lower abdominal palpation — The urinary bladder may be
palpable, either on abdominal or rectal examination. Deep
suprapubic palpation will provoke discomfort.
●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. A
normal prostate examination does not preclude BPH as a
cause of obstruction.
●Pelvic examination — Women with urinary retention should
have a pelvic examination.
●Neurologic evaluation — The neurologic examination should
include assessment of strength, sensation, reflexes, and
muscle tone.

20. Initial management :prompt bladder decompression. This
can be accomplished with urethral or suprapubic
catheterization. Patients who have had recent urologic surgery
(eg, radical prostatectomy or urethral reconstruction) and
develop acute retention should not have urethral
catheterization; an initial attempt at urethral catheterization is
appropriate for most other patients. We generally have
patients return in one to two weeks.

21. SURGICAL THERAPY :
Surgical therapy remains the definitive
treatment of AUR. Among symptomatic
patients with BPH, transurethral resection of
the prostate.

22. -Acute urinary retention (AUR) is the most common
urologic emergency, affecting 1 in 10 men age 70
and older.
-Benign prostate hyperplasia (BPH) is the most
common underlying condition, but multiple etiologies
may cause AUR.
-Initial management of AUR involves prompt bladder
decompression.

23. 1-http://www.uptodate.com
2-National Kidney and Urologic Diseases
Information Clearinghouse