0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

EXAM

■ Findings vary with cause of obstruction (eg, enlarged prostate c/w BPH).

■ Abdominal tenderness

■ Palpable bladder (if containing > 150 mL)

DIAGNOSIS

■ UA to evaluate infection, tumor, calculi

■ BUN and creatinine to evaluate renal function

TREATMENT

■ Supportive care with analgesia

■ Placement of a 16- or 18-inch French urethral catheter or Coudé catheter

■ Donotclamp catheter.

■ Bladder aspiration if Foley catheter cannot be placed and urology consul-

tant is unavailable

■ Observation of patients with chronic retention for the development of pos-

tobstructive diuresis (4–6 hours)

■ Discharge with catheter in place and follow up with urology.

■ Antibiotics for infection, as needed

■ Avoidance of offending drug or surgical treatment of obstruction as indicated

TABLE 18.11. Causes of Acute Urinary Retention

Penile obstruction Meatal stenosis

Paraphimosis

Phimosis

Urethral obstruction Foreign body

Hematoma

Severe urethritis

Stricture

Tumor

Prostate obstruction BPH

Cancer

Severe prostatitis

Neurogenic causes Diabetes

Multiple sclerosis

Cauda equina syndrome

Medications α-Adrenergic agents

Antihistamines

Anticholinergics

Antispasmodics

TCAs