Acute urinary retention is a pathological condition caused by the inability to empty the bladder. It is manifested by pain in the lower abdomen and in the perineum, radiating into the genital area, strong anxiety of the patient. Diagnosis is made on the basis of anamnesis data, the clinical picture and complaints of the patient, the results of examination (palpation), ultrasound and endoscopic examinations. Treatment includes catheterization of the bladder, elimination of the causes that caused urinary retention. The latter can be performed by both conservative and surgical methods.
Meaning
Acute urinary retention (AUR), or ischuria, is a relatively common condition accompanying many urological diseases. Approximately 85% of cases of pathology are detected in men over 60 years old suffering from prostatic hyperplasia or adenoma. According to medical statistics, urinary retention develops in about 10% of people of this age category.
The more frequent occurrence of the pathological condition in males is due to anatomical features – a long and narrow urethra. Isolated forms of ischuria (without the presence of the main urological disease) are registered very rarely, they can be provoked by neurogenic, endocrine or other disorders in the body.
Causes
Unlike chronic, gradually increasing ischuria, acute urinary retention is caused by a rapid pathological process. In some cases, it occurs as a sudden interruption of the urine stream during emptying. In total, there are several groups of factors that can lead to such a phenomenon:
- Mechanical reasons. Urinary retention develops due to a physical obstacle in the urinary tract – concretions, blood clots, tumor fragments. Sometimes it is noted against the background of prostatitis or prostate adenoma. The cessation of urine outflow is preceded by the intake of alcohol, spicy dishes, hypothermia, causing a rush of blood to the pelvic organs and swelling of the prostate.
- Psychosomatic factors. Emotional stress, especially in the presence of mental disorders (neurosis, psychopathy), can inhibit the reflexes responsible for urination. Clinically, this is manifested by acute urinary retention.
- Post-traumatic conditions. Pelvic injuries, surgical interventions, childbirth can disrupt the innervation of the bladder or urethra. As a result, various urination disorders develop.
- Medicinal ischuria. Taking certain medications (most often – sleeping pills, anti-inflammatory drugs, antidepressants) in some individuals provokes spasms of the urinary tract, expressed by a sudden complete or partial urinary retention.
Pathogenesis
The overflow of the bladder plays a central role in the pathogenesis of AUR when its physiological emptying is impossible. Mechanical ischuria occurs most quickly – the urethra or the entrance to it is blocked by a stone, a blood clot, a foreign body, as a result of which the outflow of urine stops. This process is facilitated in the presence of already existing narrowing of the urethra – strictures, prostatic hyperplasia.
With prostate lesions, a sudden delay in the outflow of urine is possible in the case of its edema – for example, with an exacerbation of prostatitis, a violation of the diet with adenoma. Pathogenetic processes in psychosomatic, post-traumatic and medicinal forms of the disease are quite complex and have a multifactorial nature. Most often there is a neurogenic spasm of the smooth muscle membrane of the urethra or the sphincter of the bladder.
Symptoms
The clinical picture of pathology is quite specific and obvious. Usually, the acute condition is preceded by manifestations of the underlying disease – urolithiasis, prostate lesions, urethral strictures. Patients with AUR are restless, can’t sit in one place, often take a half-bent position. The main complaints are the inability to empty the bladder, despite the strongest urges, pain in the pubic and perineal areas. The soreness and feeling of distension in the abdomen are sharply intensified when pressing slightly above the pubic symphysis. Symptoms develop within a few hours.
Sometimes the onset of the disease is especially acute – during urination, the fluid stream is abruptly interrupted, after which urine excretion stops. This indicates that the cause of the pathology was a concretion or a blood clot that blocked the lumen of the urethra. The duration of the delay can range from several hours to several days. In the vast majority of cases, the outflow of urine occurs only as a result of medical manipulations – catheterization or cystostomy. Extremely rarely, acute ischuria stops spontaneously – for example, in the case of a stone coming out or its displacement from the neck of the bladder.
Complications
Any type of urinary retention causes fluid accumulation and increased pressure in the urinary tract. The result of this is the reverse movement of fluid (from the bladder to the ureters and pelvis), which can lead to their infection. In severe cases, the urine pressure reaches such a magnitude that it provokes a hydronephrotic transformation or the appearance of a diverticulum of the bladder.
Sometimes urinary retention causes kidney failure. Relapses of pathology facilitate the development of infectious and inflammatory diseases of the urinary system – cystitis and pyelonephritis. The acute process in some cases can turn into a chronic form, cause the formation of urethral strictures and other urological pathologies.
Diagnostics
In practical urology, there are many methods for determining the presence and etiology of acute urinary retention. Usually, the diagnosis of ischuria does not cause difficulties, it is carried out at the stage of examination by a urologist. The remaining studies are more focused on finding out the causes of this condition, which is necessary for the development of etiotropic treatment and prevention of relapses. Diagnostic techniques are divided into the following groups:
- Examination and anamnesis collection. Attention is drawn to the patient’s restlessness, frequent change of body position. Protrusion is detected above the pubic joint in thin patients, a dull sound is detected with percussion. Palpation is painful, during its course a rounded elastic formation is felt in the suprapubic region. In the anamnesis, there are often urological diseases or injuries.
- Ultrasound examination. During ultrasound of the bladder, an organ overflowing with fluid is recorded. In addition, with the help of sonography, it is possible to determine the possible cause of ischuria – an enlargement of the prostate, the presence of concretions in the neck of the bladder or urethra.
- Endoscopic examination. With the mechanical nature of urinary retention, cystoscopy is used as a therapeutic and diagnostic technique. With its help, it is possible not only to detect the overlap of the urinary tract, but also to eliminate it (lithoextraction).
In some cases, additional diagnostic measures are carried out, for example, a neurologist or a psychiatrist is prescribed for a suspected psychosomatic ischuria. Differential diagnosis should be carried out with anuria. At the same time, urination does not occur in the absence of urges, an overflowing bladder is not detected during examination.
Treatment
All therapeutic measures for acute ischuria are divided into urgent or emergency and etiotropic. The first are necessary to eliminate the main manifestation of pathology – the inability to excrete urine. To restore urodynamics, several methods are used, the choice of a specific technique depends on the causes of pathology and the patient’s condition. Most often , the following manipulations are carried out for this purpose:
- Catheterization of the bladder. It is the most common method of ensuring the outflow of urine in various forms of ischuria. The advantages of the technique are considered to be relative simplicity and reliability. The placement of a catheter is contraindicated in “injected” concretions, acute inflammatory pathologies of the urethra and prostate gland,
- Suprapubic cystostomy. A surgical technique that provides for the outflow of urine through a tube installed in the incision of the bladder wall. The indication for epicystostomy is the impossibility of intraurethral catheterization.
- Conservative methods. If ischuria has a neurogenic or psychosomatic character, it is possible to restore normal urodynamics by irrigating the genitals with warm water. If this technique is ineffective, subcutaneous injections of M-cholinomimetics are used.
Etiotropic treatment of urinary retention may include the removal of stones, surgical or drug therapy of prostate diseases, taking sedatives. If ischuria is provoked by the use of antidepressants, sleeping pills, their cancellation or dosage correction and regular monitoring by a urologist are necessary.
Prognosis and prevention
In most cases, the prognosis of AUR is favorable, while ensuring the normal discharge of urine, nothing threatens the patient’s life and health. The probability of relapses and the long–term prospects of the disease depend on its causes – with urolithiasis, ischuria is often represented by a single episode, and with prostatitis it periodically repeats during periods of exacerbation of the inflammatory process.
The prevention of pathology consists in the timely treatment of urological conditions – urolithiasis, prostate lesions, hemorrhagic cystitis, urethral strictures. Provided they are eliminated or controlled by the patient and specialists, the probability of pathological urinary retention is greatly reduced.
