Section: Urology Curriculum: Curriculum, page 28
Definition
- Inability to pass urine which has many causes and can cause renal impairment
Epidemiology
- Elderly males predominate
Aetiology
- Obstructive
- Foreskin - Phimosis
- Penis - meatal stricture
- Urethral - strictures, stones
- Prostatic - BPH, cancer
- Bladder - VUJ reflux, cancer
- Functional
- Post GA
- Neurogenic bladder
- Infection
Pathophysiology
- Normal urine flow depends on pressure gradient from glomerulus to bowmans capsule, ureteric peristalsis and gravity
- When the luminal pressure is greater than ureteral peristalsis - retention
- Many causes for this
Clinical
- Lower Abdominal pain, distension, anuria, UTI, LUTs
- Palpable bladder
Investigations
- Bloods - infection, renal function, electrolytes
- Bladder scan - pre and post void volumes
- Urine spec - micro
- Renal USS - hydronephrosis or hydroureter
- CT KUB - level or ureteric obstruction (stone or extrinsic compression)
Management
- Principles
- CRISP
- Re-establishment of urinary flow to prevent renal impairment
- Options
- Transurethral catheter
- Suprapubic catheter
- JJ stent
- Nephrostomy tube
- SPC
- If unable to pass transurethral catheter - e.g. BPH/prostate cancer
Complications
- AKI or CKD
- Pan hypo electrolytes and salt losing nephropathy
- Post-obstructive diuresis and subsequent hypovolaemia