Retention of urine is inability to pass urine. It can be either acute or chronic.

Causes

1.                Mechanical causes of retention are: posterior urethral valves, foreign bodies, tumours, blood clot and stones, phimosis, paraphimosis, trauma (rupture of urethra or bladder), urethral stricture, urethritis, meatal ulcer, tumours, prostatic enlargement-benign or malignant, retroverted gravid uterus, fibroid, ovarian cyst, faecal impaction.

2.                Neurogenic causes are- postoperative retention, neurogenic bladder, spinal cord injuries, hysteria, drugs- anticholinergics, antihistaminics, and smooth muscle relaxants.

Salient Features

•           Acute retention of urine is characterized by inability to pass urine despite urge, suprapubic discomfort or severe agonizing pain. There may be previous such episodes or history of trauma, instrumentation or surgery.

•           Chronic retention is an enlarged painless bladder whether or not the patient is having difficulty with micturition. Sometimes acute episode can be precipitated in cases of chronic retention of urine.

•           There may be symptoms suggestive of prostatic enlargement in elderly male.

•           On examination, there is suprapubic swelling arising out of pelvis in the midline in the hypogastric region that is dull to percussion and cystic in nature. This helps to differentiate from anuria where urinary bladder is not palpable.

•           Rectal examination will help to confirm the prostatic pathology in elderly patients.

•           Spinal defects or neurological findings suggest presence of neurogenic bladder.

Treatment

A.  General measures

•           Sedation, adequate hydration and antibiotics if sepsis is present.

•           If there is history of trauma, urethral injury should be ruled out before attempting catheterization.

•           If urethra is patent, a catheter is passed in to the bladder under strict aseptic precautions and connected to a sterile closed collecting system. The catheter is chosen according to the size of the external meatus. In cases of acute retention, single catheterization is adequate or an indwelling self-retaining catheter is inserted if deemed necessary.

B.  Surgical Management

•           If urethral pathology is present or there is inability to pass the catheter, a suprapublic puncture or cystostomy is performed to relieve the retention.

•           In case of chronic retention, decompression should be performed intermittently (300-400 ml volume) to avoid haematuria that can occur after sudden decompression.

•           That patient should be kept under observation after admission for investigation to elucidate the cause of retention. The investigations include urine examination, renal functions, plain and contrast radiological studies; ultrasound, CT scan or MRI. Urodynamic studies are required to diagnose neurogenic bladder. Cystoscopy can help to diagnose and treat many conditions of the urethra and urinary bladder.

C.  Definitive treatment of the aetiology is done after proper investigations.

D.  Pharmacological

1.         Tab. Cotrimoxazole (960mg) 2 times a day Or

Tab. Norfloxacin 400mg 2 times a day for 5-7 days.

This may be changed according to urine culture and sensitivity reports.

E.  Patient education

•           Explain catheter care-measures - tip of the urethra should be cleaned with antiseptic solution regularly.

•           Watch for blood in urine.