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7.09 Urinary Retention


Presentation

The patient may complain of increasing dull low abdominal discomfort and the urge to urinate, without having been able to urinate for many hours. A firm, distended bladder can be palpated between the symphysis pubis and umbilicus. Rectal exam may reveal an enlarged and/or tender prostate or suspected tumor.

What to do:

What not to do:

Discussion

Urinary retention may be caused by stones lodged in the urethra or urethral strictures (often from gonorrhea); prostatitis, prostatic carcinoma, or benign prostatic hypertrophy; and tumor or clot in the bladder. Any drug with anticholinergic effects or alpha adrenergic effects such as antihistamines, ephedrine sulfate and phenylpropanolamine can precipitate urinary retention. Neurologic etiologies include cord lesions and multiple sclerosis. Patients with genital herpes may develop urinary retention from nerve involvement. Urinary retention has also been reported following vigorous anal intercourse. The urethral catheterization outlined above is appropriate initial treatment for all these conditions.

Sometimes hematuria develops midway through bladder decompression, probably representing loss of tamponade of vessels injured as the bladder distended. This should be watched until the bleeding stops (usually spontaneously) to be sure there is no great blood loss, no other urologic pathology responsible, and no clot obstruction.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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