ACUTE URINARY RETENTION
MANAGEMENT
BY :Kemeria Kemal
May,2010

INTRODUCTION
• Acute urinary retention (AUR) is the most
common urologic emergency. It occurs most
frequently in men over age 60, and is often the
result of benign prostatic hyperplasia

ETIOLOGY
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BPH
Constipation
Prostate cancer
Urethral stricture
Neurologic disorder
Medications/drugs
Urolithiasis
Phimosis or paraphimosis,
Genitourinary infections — acute prostatitis, urethritis,
perianal abscess

CLINICAL PRESENTATION
–
AUR presents as the abrupt inability to pass urine.
– It is typically associated with lower abdominal and/or
suprapubic discomfort .
– Affected patients are often restless, and may appear
in considerable distress.

EVALUATION
The patient history should focus on a previous history of
retention, surgery, radiation, or pelvic trauma.
The patient should also be asked about the presence of
hematuria , dysuria, fever, low back pain, neurologic
symptoms.
Finally, a complete list of prescribed and over the
counter medications should be obtained.

physical examination
– Lower abdominal palpation — The urinary bladder
may be palpable, either on abdominal or rectal
examination.
– Rectal examination — A rectal examination should
be done in both men and women, to evaluate for
masses, fecal impaction, perineal sensation, and
rectal sphincter tone.
– Pelvic examination — Women with urinary retention
should have a pelvic examination.
– Neurologic evaluation

MANAGEMENT
1.Bladder decompression with a Foley catheter is
the mainstay of treatment. .
– When a standard Foley catheter cannot be passed easily, sterile
2% viscous lidocaine can be injected through the urethra. This
anesthetizes and relaxes the sphincter, allowing gentle passage
of catheter.
– Catheterization should not be attempted when a urethral injury
is suspected
– Never use force.

2 .Emergency suprapubic puncture with
• A long needle or
• A trocar & plastic tube
Indication;
-when catheterization has failed
-Rapture of the urethera
C/I ;
-An empty bladder(if the pt has extravasation of urine
-Carcinoma of the bladder causing retention
Cxn;
-cellulites
-Injury to the prostate
-Bowl Perforation
-Urinary peritonitis

3. Open suprapubic cystostomy
A , temporary
Indication
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
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
When the bladder is not sufficiently distended
Rapture of the bladder
The treatment of clot retention
As a necessary step in a urethroplasty
C/I
-If the pt has carcinoma of the bladder
B , permanent
Indication
 a very tight stricture
 If the pt is too ill for surgery

• Patients should be monitored for post obstructive
diuresis. This is a physiologic response to a hypervolemic
state. Occasionally, it can become a pathologic diuresis
and may warrant hospital observation, with fluid and
electrolyte replacement.
• Urine output greater than 200 mL/hour for more than 2
hours should be replaced with 0.5 mL of intravenous
saline for each 1 mL of urine. Electrolytes should be
checked every 6 hours initially and replaced as needed.

References
1. UpToDate, Word wide Clinical
Community,2008
2. PRIMARY SURGERY ,vol. 1
3. The Washington manual of surgery, 5th ed