Ashiv Patel The management of urinary retention is one of importance, particularly as most patients presenting with urinary retention can be managed using an ‘ambulatory’ model. Urinary retention occurs most frequently in men over the age of 60, with this risk increasing with age. Males are 13 times more likely to be affected by acute urinary retention (AUR) than women. Over a five‐year period, 10% of men over 70 will develop AUR whilst 30% of men over 80 will be affected. An ambulatory approach will result in a reduced financial burden, better utilisation of inpatient beds and an improvement in patient‐based outcomes through a reduction in admissions. Aside from advancing age, the presence of lower urinary tract symptoms (LUTS), larger prostate volume and previous spontaneous retention are all considered risk factors for urinary retention in men. Acute urinary retention (AUR) is defined as a painful inability to pass urine, followed by relief on draining the bladder through utilising a catheter. It is normally associated with >500 ml of urine being drained. AUR can be classified as either being spontaneous or precipitated by an event. If the precipitating cause (e.g., infection) is treated, the retention usually resolves; however, spontaneous retention usually requires more definitive management. Defined as a non‐painful bladder that is still palpable after voiding and post‐void residual volumes in excess of 300 ml being present within the bladder. Defined as a painful inability to pass urine, followed by relief on draining the bladder through utilising a catheter. It is normally associated with bladder volumes far in excess of 500 ml, typically 1000 ml or more. Both benign and malignant prostatic enlargement can cause urinary retention. These patients commonly present with lower urinary tract symptoms (LUTS); however, they may present more acutely with urinary retention. Due to a narrowing of the urethra, an outflow obstruction can occur secondary to a stricture that results in urinary retention. Faecal constipation can cause urinary retention by obstructing the urethra. Infection or inflammation of the bladder, urethra, or prostate can cause obstruction of the urethra and lead to urinary retention. Urinary retention is precipitated by the obstruction of the urethra by clots formed secondary to haematuria. Any amount of macroscopic haematuria can result in clot retention; however, the subset of patients at greatest risk are those without sufficient bladder irrigation post‐operatively. Drugs can be a precipitating cause of urinary retention. Drugs that commonly cause urinary retention include anaesthetics, anticholinergics, and sympathomimetic agents. Abdominal pain and associated pelvic floor contraction can make it difficult for patients to pass urine, and adequate analgesic control is important in order to allow the patient to pass urine. There are a number of risk factors for urinary retention post‐operatively. These include surgery involving the anorectum or perineum, bladder over‐distension, instrumentation of the lower urinary tract, the use of epidural anaesthesia, and immobility in the post‐operative period. Pelvic fracture and urethral injury will cause urinary retention because the urine is unable to pass down a disrupted urethra. Conditions that cause central nervous system disfunction can cause detrusor areflexia or detrusor sphincter dyssynergia. Fowler’s syndrome is thought to cause impaired relaxation of the external urethral sphincter and can also cause urinary retention.
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Urethral Catheters and Ambulatory Management of Urinary Retention
Risk Factors
Definition of Acute Urinary Retention
Definition of Chronic Urinary Retention
Definition of Acute‐on‐Chronic Retention
Causes of Urinary Retention
Prostatic Enlargement
Urethral Strictures
Constipation
Infection
Haematuria leading to Clot Retention
Drugs
Pain
Post‐operative Retention
Pelvic Fracture and Urethral Injury
Neurological Conditions (Parkinson’s Disease, Multiple Sclerosis, Fowler’s Syndrome)
Cauda Equina
Related posts:
Role of Nurse Practitioners in Ambulatory Urogynaecological Care
The Management of Recurrent Urinary Tract Infections
Ambulatory Management of Renal Stone Disease
An Ambulatory Approach to Benign Prostatic Obstruction
Magnetic Resonance Imaging in Urology
Common Urethral and Vaginal Lesions in Ambulatory Urogynaecology
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