Surgery Sgd (Bharat Sir)

Acute & Chronic Retention of urine
SGD Surgery
Nehil Malviya 57
Omkar Harad 37
Retention of Urine
• It is accumulation of urine in the urinary bladder. Kidneys excrete urine in normal

quantity. But patient passes only small amount of urine or does not pass urine at all
causing distended bladder. In anuria due to renal fai lure, patient does not pass
urine as kidney does not secrete any urine and bladder is not distended.
• Retention can be ACUTE; CHRONIC; RETENTION WITH OVERFLOW. Retention
differs in male,female and in infants and children.
• Chronic retention is due to BPH, bladder neck contracture, urethral stricture, etc.
and is painless with suprapubic dullness.
• It is one of the common conditions seen in surgical casualty.
ACUTE RETENTION
• It is rare. It is sudden inability to pass urine. It is painful distension of the bladder. It is seen in
urethral trauma, due to anaesthesia, or surgery (perineal/abdominal). There is increased desire to
pass urine
CHRONIC RETENTION
• Chronic retention is gradual collection of urine in the bladder due to ineffective emptying of the
bladder completely. Bladder is distended and is painless. It is common in elderly. Frequency,
difficulty in urination, overflow incontinence is common. Infection in such chronic retention makes it
painful.
• These patients are at risk of upper tract dilatation because of high intravesical tension – they
require urgent urological referral. Men with impaired renal func- tion may develop post obstructive
diuresis following catheterisation. Such men need careful monitoring, with replacement of
inappropriate urinary losses by intravenous saline; they are also at risk of haematuria as the
distended urinary tract empties. Often it is several days before full renal recovery occurs.
ACUTE ON CHRONIC RETENTION: Patient is having chronic obstructive condition like BPH; due to infection and acute inflammation
and oedema of mucosa of urethra sudden total blockage sets in causing acute on chronic retention of urine.
CAUSES
CAUSE IN INFANTS AND CHILDREN
• POSTERIOR URETHRAL VALVE

• MEATAL STENOSIS
Clinical features
• Pain and swelling (fullness) in the suprapubic region.
• Inability to pass urine
• Smooth, soft, tender swelling in hypogastric region which is dull on percussion& the bladder is palpable
• Per rectal examination to see prostate(feature relevant of specific cause)
• Potential neurological causes should be excluded by checking reflexes in the lower limbs and perianal sensation
Investigation
• ULTRASOUND ABDOMEN
• BLOOD UREA
• SERUM CREATINE
• URINE MICROSCOPY
USG SHOWING ACUTE URINE RETENTION

TREATMENT
• Treatment is to pass a fine urethral catheter (14F – French gauge is defined as the
circumference in millimetres) and arrange urological management. Occasionally, in
postoperative retention a warm bath can help
• If it fails then suprapubic cystostomy using malecots catheter is done
• Treatment of the underlying cause
• Intermittent catheterisation in neurogenic bladder
Uretheral catheterisation
• Following a thorough hand wash, sterile gloves are donned. The genitalia are cleaned using soapy antiseptic. Lignocaine gel is inserted into the
urethra, warning the patient that this may create stinging. The jelly should be massaged posteriorly in an attempt to anaesthetise the sphincter
region, and it is of advan- tage to place a penile clamp for several minutes.
• A small Foley catheter should be passed while the penis is held taut. In a female patient, the labia should be parted using the middle and index
fingers of the left hand, which should not be moved once clean- ing has been performed. Providing a stricture is not the cause, the catheter
should pass freely. Once urine begins to drain it is wise to pass a few more centimetres of catheter into the bladder before the balloon is inflated
to avoid inflation in the prostate. Force must not be used
• If the catheter will not pass, it is usually due to poor technique, lack of anaesthesia, traumatisation of the urethra or a urethral stricture.
Occasionally, a large prostatic middle lobe may prevent the catheter entering the bladder; sometimes a coudé catheter will pass. If a catheter
cannot be passed the following plan should be pursued.
SUPRAPUBIC PUNCTURE
Suprapubic puncture with commercially available catheters such as Cystofix or Lawrence Add-a-Cath catheters is
straightforward provided that the bladder is palpable. The skin, fascia and retropubicspace are anaesthetised with 0.5%
lignocaine. Correct placement is confirmed by aspiration. A large-bore needle is then placed into the bladder, down
which a fine catheter is passed (Cystofix) and then secured in position. The other option is to place a plastic suprapubic
trocar and cannula, which has a removable plastic strip on the side. A standard 12F Foley catheter can be passed down
the cannula, the balloon is inflated, the cannula is extracted and the strip is pulled away from the catheter (Add-a-Cath).
If urine cannot be aspirated through the fine-bore needle, passing a suprapubic trocar should not be attempted.
If these devices are not available, a catheter can be placed in the bladder under direct vision through a small incision
under local anaesthetic.
URETHRAL INSTRUMENTATION
In a patient with a known stricture, an experienced urologist may elect to dilate the stricture or to take the
patient to theatre to carry out an optical urethrotomy
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Surgery Sgd (Bharat Sir)

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Acute & Chronic Retention of urine

• It is accumulation of urine in the urinary bladder. Kidneys excrete urine in normal

CAUSE IN INFANTS AND CHILDREN

• POSTERIOR URETHRAL VALVE

USG SHOWING ACUTE URINE RETENTION

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