Retention of urine occurs when one is unable to completely empty the bladder. It can be acute, occurring suddenly due to obstruction, or chronic, developing over time. Acute retention requires immediate catheterization to drain the bladder, while chronic retention involves identifying and treating the underlying cause of the partial obstruction. A thorough history, exam, and testing is needed to determine if the retention is due to issues in the bladder, prostate, urethra, or other causes and select the appropriate management.

1. Retention of urine
HAMAD EMAD HAMAD DHUHAYR
10110067

3. Definition
Urinary retention is defined as the inability to completely or
partially empty the bladder.
It is a sudden painful inability to urinate inspite of a full bladder
Urinary retention, also known as ischuria, is a lack of ability to urinate
Suffering from urinary retention means you may be unable to
start urination, or if you are able to start, you can’t fully empty
your bladder.

4. Normal micturition cycle:
A. Filling: Impulses from the CNS to sympathetic and
pudendal nerves relax the bladder and close the outlet.
B. Voiding: Inhibition of sympathetic and pudendal impulses.
Stimulation of parasympathetic (S2-4) leads to detrusor
contraction → voiding in the absence of obstruction

5. Acute Urinary retention
Painful inability to void, with relief of pain following
drainage of the bladder by catheterization.
Pathophysiology:
◦Increased urethral resistance, i.e., bladder outlet
obstruction (BOO)
◦Low bladder pressure, i.e., impaired bladder contractility
◦Interruption of sensory or motor innervations of the
bladder.

6. Differential diagnosis of acute retention and
obstructive / anuria
Acute retention obstuctive Anuria
Desire to urinate + - -
Suprapubic pain + - -
Renal pain - - +
General exam. Good May be uremic
Abdominal exam. Tender Full bladder Empty
Loin bladder

7. Acute urinary retention…
Causes :
◦ Men:
◦ Benign prostatic enlargement (BPE) due to BPH
◦ Carcinoma of the prostate
◦ Urethral stricture
◦ Prostatic abscess
◦ Women
◦ Pelvic prolapse (cystocoele, rectocoele, uterine)
◦ Urethral stricture;
◦ Urethral diverticulum;
◦ Post surgery for ‘stress’ incontinence
◦ pelvic masses (e.g., ovarian masses)

8. Acute urinary retention…
Causes…
Both Sex
◦ Haematuria leading to clot retention
◦ Drugs
◦ Pain
◦ Sacral nerve compression or damage(cauda equina compression )
◦ Radical pelvic surgery
◦ Pelvic fracture rupturing the urethra
◦ Neurotropic viruses involving the sensory dorsal root ganglia of S2–S4 (herpes simplex or
zoster);
◦ Multiple sclerosis
◦ Transverse myelitis
◦ Diabetic cystopathy
◦ Damage to dorsal columns of spinal cord causing loss of bladder sensation (tabes dorsalis,
pernicious anaemia).

9. Acute urinary retention…
Initial Management :
◦Urethral catheterisation
◦Suprapubic catheter ( SPC)
Late Management:
◦Treating the underlying cause

10. Chronic urinary retention
Obstruction develops slowly, the bladder is distended
(stretched) very gradually over weeks/months, so
pain is not a feature .
Presentation:
◦ Urinary dribbling
◦Overflow incontinence
◦Palpable lower suprapubic mass

11. Chronic Retention of Urine
Causes: Long standing incomplete obstruction
A) Mechanical : BPH, prostate cancer
B) Functional: Neuropathic flaccid bladder.
- Large amounts of residual urine exist.
- When the vesical pressure exceeds the urethral resistance, the patient can
pass some urine or dribble continuously. This is called false or overflow
incontinence.

12. Differentiation between acute and
chronic urine retention
Acute retention Chronic retention
Urination No urine Overflow incontinence
Pain Severe, suprapubic, Painless
bursting
Obstruction Complete Partial
Suprapubic + +/-
tenderness

13. Causes according to site
In the bladder
⇒ Detrusor sphincter dyssynergia
⇒ Neurogenic bladder (commonly pelvic splanchic nerve damage,
cauda equina syndrome, descending cortical fibers lesion
, pontine micturation or storage center lesions,
demyelinating diseases or Parkinson's disease)
⇒ Iatrogenic scarring of the bladder neck
(commonly from removal of indwelling catheters
or cystoscopy operations)
⇒ Damage to the bladder
In the prostate
⇒ Benign prostatic hyperplasia
⇒ Prostate cancer and other pelvic malignancies
⇒ Prostatitis
.

14. Penile urethra
⇒ Congenital urethral valves
⇒ Phimosis or pinhole meatus
⇒ Circumcision
⇒ Obstruction in the urethra, for example a metastasis or
a precipitated pseudogout crystal in the urine
⇒ STD lesions (gonorrhoea causes numerous strictures,
leading to a rosary bead appearance,
whereas chlamydia usually causes a single stricture)

15. Other
⇒ Paruresis ( shy bladder syndrome )-, urinary retention can result
⇒ Consumption of some psychoactive substances, mainly stimulants,
such as amphetamine.
⇒ Use of NSAIDs or drugs with anticholinergic properties.
⇒ Stones or metastases can theoretically appear anywhere along
the urinary tract, but vary in frequency depending on anatomy

16. History
Duration
Painfull?
Precipitating factors
Preceding LUTS
Other urinary complaints
Differential diagnosis
Medical illnesses - D/D, co-morbidity

17. Catheterization
◦Easy
◦Caliber
◦Urine quantity / color
◦Where / by whom
◦ TWOC

18. Examination
Meatus
Urethra
Bladder
DRE
Hernia
Neurological ex
◦ Higer mental functions
◦ Cranial nerves
◦ Lower limb
◦ perineum - sensations

19. Investigations
Urine
RFTS
US
X ray KUB
Urodynamics study
Cystoscopy

20. Treatment
Urethral catheterization
◦Technique
◦ Explain / consent ( need / discomfort)
◦ Keep Items ready
◦ Theatre / dressing room / bed
◦ Supine posture legs separated
◦ Female – knee bent & separated, feet together
◦ Gloves

21. Referrences
Matary
Baily
Website