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June 4, 2015 by dailybolusoflr
By Julie Rice, MD
Obstruction (stricture, calculi, foreign body, BPH)
Infection (UTI, HSV)
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)**
- DRE for tone/perineal sensation and to eval for prostate enlargement or tenderness.
- Women may need pelvic to look for infections/masses
- Sympathetic nerves that control bladder originate from T10-L2 vertebrae.
- Look for signs of peripheral neuropathy
- Bladder cath- measure void
- UA, Urine culture
- BMP if you suspect renal involvement
- Malignancy causing obstruction
- Spinal cord injury/compression
- Hematuria resulting in repeat clotting of foley or significant bleed.
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