Urinary Retention

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of urinary retention symptoms

Symptoms include:

‍inability to urinate despite the urge

‍weak urinary stream

‍straining to urinate

‍incomplete bladder emptying

‍nocturia

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍lower back pain

‍burning on urination

‍urinary frequency



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

no history of: ‍prostate enlargement, ‍bladder dysfunction, ‍urinary tract abnormalities, ‍neurological disorders, ‍recent abdominal surgery, ‍spinal cord injury

no use of: ‍decongestants, ‍antihistamines, ‍antidepressants, ‍diuretics, ‍opioids, ‍new medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

Urinary retention due to ‍Benign prostatic hyperplasia ‍likelysuspectedpossible

DDx: acute urinary retention, chronic urinary retention, benign prostatic hyperplasia, urinary tract infection, neurogenic bladder, medication side effect, urethral stricture, prostate cancer, bladder stones, cystocele, pelvic organ prolapse, constipation, spinal cord injury, multiple sclerosis, diabetes mellitus, stroke, Parkinson's disease, anticholinergic medication, anesthesia or sedative use, postoperative urinary retention, pelvic mass





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍CRP, ‍PSA

- Urinalysis

- Urine culture

- Renal ultrasound

- CT scan of the abdomen and pelvis

- Post-void residual urine volume

Treatments:

- ‍Alpha-blockers

- ‍5-alpha reductase inhibitors

- Catheterization

- Stop medications that may be causing urinary retention (decongestants, antihistamines, antidepressants, diuretics, opioids)

Further care:

- Referral to urologist

- Keep catheter in place until urologist appointment

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as fever, hematuria, or urinary incontinence

- Referral to ER if unable to urinate or severe lower abdominal pain