Urinary Retention
Acute:
· BPH
· It is often precipitated during a cold, by the use of antihistamines and nasal drops, and by abundant fluid intake.
· The patient wants to void but cannot, and the huge distended bladder is palpable.
· Tx: An indwelling bladder catheter needs to be placed and left in for at least 3 days.
o First line of long-term therapy is alpha-blockers, the most selective of which is tamsulosin.
o 5-Alpha-reductase inhibitors, like finasteride or dutasteride, are used for very large glands (more than 40 g).
o TURP remains the final surgical option for benign prostatic hypertrophy.
Post-op
· This is gonna be overflow incontinence
· Pt will complain of small amount of urine
· Distended bladder
· Tx: urethral catheter
Urinary Incontinence
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Type
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Pathogenesis
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S/S
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Dx
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Tx
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Stress
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increased urethral mobility
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· Urinary incontinence with ↑ intra-abdominal pressure
· e.g., coughing, sneezing, laughing, and physical exertion
· No urine loss at night
· cystocele may be present
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· Q-type test*
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· 1˚ Kegel exercises
· Topical estrogen for post-menopausal women
· Pessary
· Midurethral sling in patients unresponsive to initial therapy and pessary
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Urge
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· Detrusor muscle overstimulation
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· Frequent urinary leakage
· also occurs at night
· disrupts sleep
· Urge to urinate and may be unable to reach the bathroom in time
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· Urodynamic testing
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· Antimuscarinics (oxybutynin)
· Mirabegron
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Overflow
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· Incomplete bladder emptying results in urinary leakage 2˚ to
detrusor muscle underactivity
· age, diabetes mellitus, and multiple sclerosis
· bladder outlet obstruction
· fibroids and benign prostatic hyperplasia
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· Urine loss without warning or triggers
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· Post-void residual volume measurements ⤴️
· Urodynamic testing
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· Clean intermittent catheterization
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Mixed Incontinence
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· Symptoms of both stress and urge incontinence
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–
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· Life style modifications and pelvic floor exercises is first-line
· If unresponsive to first-line treatments then therapy is based on the predominant symptoms
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Vesicovaginal fistula
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· Fistula that forms creating a connection between the bladder and vagina
· May be secondary to surgery, pelvic irradiation, malignancy, or prolonged labor
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· Painless, continuous leakage of urine from vagina
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· Fluid pooling in the vagina
· You put methylene blue in bladder, then the tampon in vagina is blue
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· Surgery
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Stricture
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narrowing
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sx of overflow + obstruction + rx UTI
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Surgery (ballon)
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Urinary incontinence
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Stress
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Leakage with Valsalva (coughing, sneezing, laughing)
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· Lifestyle modifications
· Pelvic floor exercises
· Pessary
· Pelvic floor surgery
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Urgency
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Sudden, overwhelming, or frequent need to void
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· Lifestyle modifications
· Bladder training
· Antimuscarinic drugs
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Mixed
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Features of stress & urgency
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· 1˚ Diary of voiding
· Tx based on dominant type
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Overflow
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Constant, involuntary dribbling & incomplete emptying
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· Identify & correct U/C
· Cholinergic agonists
· Intermittent self-catheterization
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Urethral stricture (Narrowing ><)
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Cause
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· 👨🏻 > 👩🏻
· Urethral trauma (catheterization)
· Urethritis
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Sx
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· Weak or spraying stream
· Incomplete emptying
· Irritative voiding (Dysuria, frequency)
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Comp
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· Acute urine retention
· Rx UTIs
· Bladder stones
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Dx
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· Postvoid residual, uroflowmetry
· Urethrography
· Cystourethroscopy
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Tx
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Dilation / Urethroplasty
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Fast HY Review 