Medical Minute: Acute Urinary Retention

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June 4, 2015 by dailybolusoflr

By Julie Rice, MD
Differential:
Obstruction (stricture, calculi, foreign body, BPH)
Infection (UTI, HSV)
Trauma
Medications: anti-cholinergic, anti-histamine, alpha agonists, antidepressants/antipsychotics,
antiParkinson, muscle relaxants
**Neurogenic (MS, Parkinsons, Spinal Cord Compression, neuropathy/DM)**
**Extraurinary (abscesses, abdominal aortic aneurysm)**
PE:
GU exam
  • DRE for tone/perineal sensation and to eval for prostate enlargement or tenderness.
  • Women may need pelvic to look for infections/masses

Neuro exam
  • Sympathetic nerves that control bladder originate from T10-L2 vertebrae.
  • Look for signs of peripheral neuropathy¬†

Work up:
  • Bladder cath- measure void
  • UA, Urine culture
  • BMP if you suspect renal involvement
Disposition:
Consider admission
  • Malignancy causing obstruction
  • Spinal cord injury/compression
  • Hematuria resulting in repeat clotting of foley or significant bleed.
  • Urosepsis

Urology consult (precipitated retention)
  • Concern for anatomic issue- strictures, meatal stenosis, urethral injury
  • Suspected prostate cancer
  • Acute prostatitis
  • Postoperative complications

Discharge planning for simple/spontaneous retention (90% of patients)
  • Discharge with foley catheter and leg bag.
  • F/u with primary care or urology in 3-7 days for voiding trial (if they fail the trial at primary care then they should be referred to urologist)
  • Tamulosin 0.4 mg daily- warn elderly about postural hypotension

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