Urinary Retention.pptx

URINARY RETENTION NUGROHO BUDI UTOMO

DEFINITION

Urinary Retention : • Inability to void spontaneously • Inability to void adequately  post void residual volume > 100 ml (measured by USG, catheter insertion)

DEFINITION Anuria : • No urine production Oliguria : • Urine output < 200 ml/12 hr Extreme oliguria : • Urine output < 50 ml/12 hr Campbell-Walsh Urology Surgery 10th ed

ANAMNESIS • • • • • • •

No spontaneous voiding Pain on lower abdomen Previous instrumentation Previous urologic surgery History of diabetes, stroke Haematuria Passing stone, clot

ANAMNESIS PITFALLS • Highly frequent voiding • Urine dribbling • Incontinence (overflow) SHOULD BE CONFIRMED WITH PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

TREATMENT Catheter insertion • Material and size of the catheter • Type and amount of lubricant • Appropriate/right technique

LAB EXAMINATION • • • • •

Complete blood count Renal function (serum ureum, creatinin) Serum uric acid Electrolyte Urinalysis

RADIOLOGY • • • • •

Renal, bladder ultrasound BNO / KUB (plain abdominal Ro) Pelvic Ro Urethrography Whole abdomen CT scan (if necessary)

DIFFERENTIAL DIAGNOSIS • BPH (Benign Prostatic Hyperplasia)

• Male • old age • Previous LUTS

• Neurogenic bladder

• Male > female • Co morbid : stroke, diabetes, spinal cord injury • Paresis

DIFFERENTIAL DIAGNOSIS • Urethral stone

• Urethral stricture

• Male , any age • Sudden onset • Previous disuria, hematuria • Male, any age • History of instrumentation (catheter, endoscopic surgery) • Previous small caliber urine

DIFFERENTIAL DIAGNOSIS • Clot retention

• Male > female • Previous gross haematuria • Previous passing clot • History of renal or bladder cancer • History of urologic surgery (TUR-P)

DIFFERENTIAL DIAGNOSIS • Urethral rupture

• Men • History of pelvic trauma • Straddle injury • Meatal bleeding • Scrotal/perineal hematoma

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