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Urinary retention

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In medicine, urinary retention is "inability to empty the urinary bladder with voiding (urination).[1] Ten percent of males over the age of 50 may have undiagnosed urinary retention during routine physical examination.[2][3]

In males, antimuscarinic cholinergic antagonists may contribute to retention.[4]

Diagnosis[edit]

Urinary retention may be asymptomatic.[2]

Physical examination[edit]

Physical examination may detect less than half of cases of postoperative bladder size greater than 400 ml compared to ultrasonography.[5]

Ultrasonography[edit]

Bladder ultrasonography may detect urinary retention and reduce unnecessary urinary catheterization[6], but false positives may occur due to cysts of nearby organs.[7]

Treatment[edit]

Retained volumes of more than 900 ml indicated reduced chance of successful removal of the catheter.[8]

The use of bladder ultrasonography may reduce the frequency of intermittent urinary catheterization among patients with spinal cord disorders.[9] Although the use of protocols with bladder scanners to reduce the frequency of urinary catheretization are recommended[10], implementing a critical pathway with a bladder scanner may[5] or may not[11] increase the use of scanning prior to insertion of a urinary catheter.

Postoperative urinary retention[edit]

Postoperative urinary retention (> 500 ml of urine estimated by bladder scanning) may be better treated with intermittent urinary catheterization rather than indwelling urinary catheterization.[12]

"Whilst it may appear that cholinergic agents and intravesically administered prostaglandin offer most promise in the treatment of post-operative urinary retention, the evidence is weak" according to the Cochrane Collaboration. [13]

References[edit]

  1. ↑ Anonymous (2024), Urinary retention (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 Rosenthal TC, Siepel T, Zubler J, Horwitz M (1994). "The use of ultrasonography to scan the abdomen of patients presenting for routine physical examinations.". J Fam Pract 38 (4): 380-5. PMID 8163963.
  3. ↑ Siepel T, Clifford DS, James PA, Cowan TM (2000). "The ultrasound-assisted physical examination in the periodic health evaluation of the elderly.". J Fam Pract 49 (7): 628-32. PMID 10923573. Review in: J Fam Pract. 2001 Feb;50(2):182, 185
  4. ↑ Martín-Merino E, García-Rodríguez LA, Massó-González EL, Roehrborn CG (2009). "Do oral antimuscarinic drugs carry an increased risk of acute urinary retention?". J Urol 182 (4): 1442-8. DOI:10.1016/j.juro.2009.06.051. PMID 19683302. Research Blogging.
  5. ↑ 5.0 5.1 Warner AJ, Phillips S, Riske K, Haubert MK, Lash N (2000). "Postoperative bladder distention: measurement with bladder ultrasonography.". J Perianesth Nurs 15 (1): 20-5. PMID 10839085.
  6. ↑ Sparks A, Boyer D, Gambrel A, Lovett M, Johnson J, Richards T et al. (2004 Jul-Sep). "The clinical benefits of the bladder scanner: a research synthesis.". J Nurs Care Qual 19 (3): 188-92. PMID 15326987.
  7. ↑ Alagiakrishnan K, Valpreda M (2009). "Ultrasound bladder scanner presents falsely elevated postvoid residual volumes.". Can Fam Physician 55 (2): 163-4. PMID 19221075. PMC PMC2642496.
  8. ↑ Taube M, Gajraj H (February 1989). "Trial without catheter following acute retention of urine". Br J Urol 63 (2): 180–2. DOI:10.1111/j.1464-410X.1989.tb05160.x. PMID 2641206. Research Blogging.
  9. ↑ Anton HA, Chambers K, Clifton J, Tasaka J (1998). "Clinical utility of a portable ultrasound device in intermittent catheterization.". Arch Phys Med Rehabil 79 (2): 172-5. PMID 9473999.
  10. ↑ Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ et al. (2008). "Strategies to prevent catheter-associated urinary tract infections in acute care hospitals.". Infect Control Hosp Epidemiol 29 Suppl 1: S41-50. DOI:10.1086/591066. PMID 18840088. Research Blogging. Summary at National Guidelines Clearinghouse
  11. ↑ Boyer DR, Steltzer N, Larrabee JH (2009 Jan-Mar). "Implementation of an evidence-based bladder scanner protocol.". J Nurs Care Qual 24 (1): 10-6. DOI:10.1097/NCQ.0b013e31818f52bd. PMID 19092473. Research Blogging.
  12. ↑ Lau H, Lam B (2004). "Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization.". ANZ J Surg 74 (8): 658-61. DOI:10.1111/j.1445-1433.2004.03116.x. PMID 15315566. Research Blogging.
  13. ↑ Buckley BS, Lapitan MC (2010). "Drugs for treatment of urinary retention after surgery in adults.". Cochrane Database Syst Rev 10: CD008023. DOI:10.1002/14651858.CD008023.pub2. PMID 20927768. Research Blogging.

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