Acute urinary retention – causes, symptoms, treatment
Urinating is a spinal reflex act which is under cortical control. Acute urinary retention is a urological emergency. Is defined by the inability to eliminate, through the process of micturition (the act of urine), bladder content, that appears suddenly in a person who previously urinated normally. Is accompanied by bladder dilation.
The etiology of this disease is vast. The most common causes are:
– Obstruction of bladder – which can occur in prostate hyperplasia or prostate carcinoma (cancer) , urethral stricture, urethral calculation;
– Urethral injury;
– Causes like inflammation – acute prostatitis, prostatic abscess, urethritis, periurethritis;
– Foreign body;
– Bladder tumors;
– Bladder stones;
– Retention of urine in case of neurogenic bladder;
– Drugs – antidepressants, antispasmodics, antihypertensives, antiarrhythmics, anticholinergics, sympathomimetics, Parkinson medication;
– Psychogenic – depression, abuse, psychological trauma;
– Tabesul (neurological late syphilis).
In women, urinary retention may be caused by the gravid uterus or uterine fibroids.
From clinically point of view, we find an agitated patient with abdominal pain , pale, sweaty. Micturitions are compelling, harrowing, sometimes a few drops of urine may occur when too full.
The hypogastric palpation (located above the bin) can find a full bladder, sometimes painful to touch and even at percussion.
One of the investigations, which can be made on emergency, which certifies the diagnosis is ultrasound.
As I said, acute urinary retention is a urological emergency which requires the establishment of treatment as soon as possible.
Consists of a single catheterization, useful for diagnostic and therapeutic or diversion of urine through the Ademeure catheter or suprapubic catheter for a long period.
After initiation of therapy will conduct a series of investigations to detect the cause and then they will be treated to prevent reinstallation of urine retention.
It is very important to distinguish acute retention of urine by anuria. In acute urinary retention, urinary bladder is full and in anuria (decreased until complete disappearance of urinary excretion) bladder is empty because the kidneys do not produce urine, so the patient has no sensation of urination.
The prognosis of this disease depends on precocity of diagnosis and establishment of treatment. Without treatment can occur a series of complications, some with extremely severe consequences or even death.
Uremia is a very serious complication because if bladder drainage is not provided timely the patient dies.
Another serious complication but rare is rupture of bladder which occurs due to exaggerated distension installed in a short time.
Other complications that can occur are: urinary tract infections, ascending pyelonephritis, septicemia and bladder hemorrhage.