URINARY RETENTION

This is inability to pass urine while the urinary bladder is full. There is an urge to micturate and if not relieved, there is severe pain with straining. The causes vary with age and gender.

The common causes are:

For children
  • Meatal stenosis
  • Phimosis or paraphimosis
  • Posterior urethra valves
  • Ruptured urethra after trauma
  • Constipation.
For adults aged 20–50 years
  • Urethral stricture
  • Calculi (bladder and urethral stones)
  • Bladder tumours
  • Ruptured urethra (trauma)
  • Postoperative (any perineal operation) clot retention.
For male adults older than 50 years
  • Prostatism (benign prostatic enlargement
  • Carcinoma of the prostate
  • Prostatitis
  • Prostatic fibrosis
  • calculi
  • Urethral strictures
  • Bladder tumours
  • Ruptured urethra (trauma)
  • Postoperative clot retention
For females
  • Bladder tumours
  • Calculi
  • Pelvic tumours (cancer cervix),
  • Urethral stenosis
  • Postoperative clot retention (severe haematuria).

It should be noted that spinal cord compression with paraplegia/quadriplegia results in urinary retention.

Management –- General

  • Relieve acute retention by catheterization:
    • Pass a size 20FG Foley’s catheter in adults or 10FG in children. If this passes and the bladder is emptied retain it. After urine is drained, the anteverted bladder returns to normal position.
    • All catheters must be well lubricated with non petroleum based gel (xylocaine, K-Y gel, etc.).
    • If catheterization fails, perform a suprapubic puncture 2–3cm above pubic crest
  • If catheterization fails, use cystofix or suprapubic cystostomy and refer.

Management – Specific

  • Perform circumcision for phimosis or paraphimosis [see circumcision].
  • Refer more complicated cases.
  • Carry out prostatectomy and urethroplasty as indicated.
  • Treat cancer as indicated in cases of malignancy.