The document discusses acute urinary retention and acute renal failure. It defines the conditions and outlines their causes, which can be pre-renal, renal, or post-renal in nature. The evaluation and management of the conditions is also described. Causes include issues like decreased perfusion, obstruction, toxicity, and inflammation. Treatment involves supportive care, addressing the underlying cause, and dialysis in some situations to manage electrolyte and acid-base imbalances.

1. Urology Department
Under-graduate courses
Anuria and Acute Urinary
Retention
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

2. For our Lectures and Scientific resources
visit our web sites,
Uroainshams.blogspot.com
Uronotes2012.blogspot.com
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3. Anuria and Acute renal failure (ARF)
Definition
• no urine output or less than 200 ml/24 hours (while bladder
is empty).
Differential diagnosis:
 Urinary retention (bladder is full)
Causes
• Pre renal (functional)
• Renal-intrinsic (structural)
• Post renal (obstruction)
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

4. CAUSES OF ARF

5. Causes of Pre-renal ARF
Decreased renal perfusion due to:
• hypovolaemia,
• hypotension,
• impaired cardiac function
• Advanced liver disease
• renal vascular disease.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

6. Causes of renal (Intrinsic) ARF
• Acute tubular necrosis (ATN)
– Ischaemia
– Toxin (e.g., aminoglycoside, antibiotics, contrast media)
– Tubular factors
• Acute interstitial Necrosis (AIN)
– Inflammation
– Oedema
– Drugs (sulfa drugs, penicillin, furosemide, hydrochlorothiazide)
• Glomerulonephritis (GN)
– Damage to filtering mechanisms
– Multiple causes
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

7. Causes of Post-renal ARF
• Post renal obstruction due to
– Prostatic hypertrophy
– Blocked catheter
– Malignancy (obstructing both ureters):
 Bladder cancer.
 Prostatic cancer
 Retroperitoneal tumors or pathology
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

8. Evaluation of ARF
Pre-renal
• Evaluate Circulatory System & Check Volume Status
• Urinalysis is typically unremarkable.
• Evaluate Renal Vasculature: by renal scan
Renal (Intrinsic)
• Urinalysis: tubular cell casts during the early ATN. Urine
specific gravity is fixed at 1010 and the urinary sodium
concentration > 30 mEq/L. Proteinuria in glomerular
disease.
• History of Nephrotoxins (ATN) or drugs (interstitial
nephritis)
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9. Evaluation of ARF
Post-renal
• Bladder Outlet obstruction: Place a Foley
catheter or irrigate pre-fixed catheter.
• Upper Tracts: Abdominal Ultrasound.
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10. Management of ARF
Supportive treatment
• Support with dialysis may be needed
• Restrict sodium, potassium, and fluid intake.
• Treat hyperkalemia and acidosis
Pre-renal
• restore volume, support blood pressure, and
treat sepsis or cardiac failure.
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11. Evaluation of ARF
Post-renal - RELIEF THE OBSTRUCTION
• Bladder Outlet obstruction: Place a Foley
catheter.
• Upper Tracts: JJ stent or nephrostomy tube then
definite surgery later.
Renal (Intrinsic)
• stop any nephrotoxic drugs (i.e., change
antibiotics as needed, discontinue NSAIDs).
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12. Indications for acute dialysis
• Acidosis (metabolic)
• Electrolytes (hyperkalemia)
• Ingestion of drugs/Ischemia
• Overload (fluid)
• Uremia
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

13. Urinary retention
Definition
• Inability to empty the bladder
Types of Retention
Acute urinary retention Complete and painful inability to
empty the bladder and < 800 ml of urine is drained
Chronic urinary retention inability to completely empty
bladder and leave large amount of post-void volume.
Acute-on-chronic urinary retention Complete and painful
inability to empty the bladder and >800 ml of urine is
drained
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By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

14. Urinary retention
Causes of urinary retention
– Benign prostatic hyperplasia (BPH)
– Prostatic carcinoma
– Urethral stricture
– Pelvic mass (especially in women)
– Urinary tract infection
– Constipation
– Neurological
– Postoperative pain or immobility
Types of Retention
can be acute or chronic or acute-on-chronic
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By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

15. Acute Urinary retention (AUR)
• Acute retention is characterized by an acute
onset of suprapubic discomfort associated
with the desire, but inability to urinate.
• It is typically seen in men, when the cause is
usually obstructive: for example, benign
prostatic hyperplasia, prostate cancer or
urethral stricture.
• It can occur in women, due to pelvic mass or
neurogenic bladder.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

16. Acute Urinary retention (AUR)
• AUR may be associated with previous LUTS:
obstructive and irritative.
• Typically, patients have increasing preceding
LUTS till reaches complete retention.
• Usually those patients have acute-on-chronic
retention.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

17. Acute Urinary retention (AUR)
• AUR can be precipitated by:
 Medications e.g. anticholinergic or sympathomimetic
agents (cough and cold remedies).
 Urinary infection.
 Excessive fluid intake.
 Consequences of surgery (postoperative pain, effects
of anesthesia or analgesia and loss of mobility).
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

18. AUR- Initial Management
• Urethral catheterization is straightforward and will relieve
the patient’s symptoms instantly.
• Suprapubic catheterization is used in patients with a
history of urethral stricture or previous traumatic
catheterisations,
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

19. AUR- Further management
Acute retention
A trial of catheter removal after alpha blocker is justified.
Acute –on-chronic retention (residual urine > 800cc)
• they should probably proceed to (TURP)
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

20. Clot retention
• Retention due to obstruction of urine
pathway by blood clots filling the
bladder.
• occur as a result of bleeding from a
renal or bladder tumor or,
commonly, following TURP.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

21. Clot retention- investigations
Lab
• measuring baseline haemoglobin, platelets
and blood clotting.
Radiology
• IVU is the traditional investigation for
hematuria.
• Pelvi-abdominal U/S for masses or prostatic
enlargment.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

22. Clot retention- management
• Resuscitation by a wide bore IV line,
monitoring vital data and blood transfusion.
• Triple-way catheter (22 or 24 Ch) to
evacuate clot and irrigate the bladder
• Anticoagulant and antiplatelet drugs
should be stopped, if feasible.
• cystoscopy after the bleeding has
settled down and the catheter has been
removed, to identify and treat the cause.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS

23. Thank You
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS