Acute Urinary Retention

ACUTE URINARY
RETENTION
Roheman, S.Kep, Ners, M.Kep

NEUROPHYSIOLOGY
• NERVE SUPPLY
The lower urinary tract receives afferent and efferent
innervation from both the autonomic and somatic nervous
systems. The parasympathetic innervation originates in the
second to fourth sacral segments. The cholinergic
postganglionic fibers supply both the bladder and smooth-
muscle sphincter.
The sympathetic nerves originate at T10–L2. The
noradrenergic postganglionic fibers innervate the smooth
muscles of the bladder base, internal sphincter, and
proximal urethra.
Somatic motor innervation originates in S2–3 and travels to
the striated urethral sphincter via thepudendal nerve.
• The Micturition Reflex
The pontine center, through its connection
with the sacral center, may send either
excitatory or inhibitory impulses to regulate
the micturition reflex. Electrical or chemical
stimulation of the neurons in the medial
pontine micturition center generates
contraction of the detrusor and relaxation of
the external sphincter.
• The Storage Function
The external sphincter plays an important role
in urine storage. The afferents from pelvic and
pudendal nerves activate both the sacral and
lateral pontine center; this enhances
sphincteric contraction while suppressing the
parasympathetic impulse to the detrusor.
• Cerebral (Suprapontine) Control
Although micturition and urine storage are
primarily functions of the autonomic nervous
system, these are under voluntary control
from suprapontine cerebral centers, so that
other groups of muscles (arm, leg, hand,
bulbocavernosus) can be integrated to assist
in urination at the appropriate time and place.
• Neurotransmitters & Receptors
In parasympathetic innervation, acetylcholine
and nicotinic receptors mediate pre- to
postganglionic transmission, while
acetylcholine and M2 muscarinic receptors
mediate the postganglionic neuron–smooth
muscle transmission.
Afferent and efferent pathways and central Pathways and central nervous system
nervous system centers involved in micturition centers involved in urine storage.
URINARY RETENTION
• Urinary retention is the inability to voluntarily
urinate. Acute urinary retention is the sudden
and often painful inability to void despite
having a full bladder. Chronic urinary retention
is painless retention associated with an
increased volume of residual urine.
Causes of Urinary Retention
OBSTRUCTIVE
• Obstruction of the lower urinary tract at or
distal to the bladder neck can cause urinary
retention.
• The obstruction may be intrinsic (e.g.,
prostatic enlargement, bladder stones,
urethral stricture) or extrinsic (e.g., when a
uterine or gastrointestinal mass compresses
the bladder neck causing outlet obstruction)
INFECTIOUS AND INFLAMMATORY
• The most common cause of infectious acute
urinary retention is acute prostatitis
• Urethritis from a urinary tract infection (UTI)
or sexually transmitted infection can cause
urethral edema with resultant urinary
retention, and genital herpes may cause
urinary retention from local inflammation and
sacral nerve involvement (Elsberg syndrome)
• In women, painful vulvovaginal lesions and
vulvovaginitis can cause urethral edema, as
well as painful urination, which also results in
urinary retention
PHARMACOLOGIC
NEUROLOGIC
• Neurogenic or neuropathic bladder is defined
as any defective functioning of the bladder
caused by impaired innervation
• Up to 56 percent of patients who have
suffered a stroke will experience urinary
retention, primarily because of detrusor
hyporeflexia.
• Up to 45 percent of patients with diabetes
mellitus and 75 to 100 percent of patients
with diabetic peripheral neuropathy will
experience bladder dysfunction, which is likely
to include urinary retention
OTHER CAUSES
• Postoperative Complications
• Pregnancy-Associated Urinary Retention
• Trauma
URETHRAL CATHETERIZATION
• Urethral catheterization is performed for
diagnosis and treatment of urologic disease
• Many types of catheters are available for
urethral catheterization
• The choice of a specific type of catheter
depends on the reason for catheterization
• Catheter size is usually referred to using the
French (Fr) scale (circumference is in
millimeters), in which 1 Fr = 0.33 mm in
diameter
• Catheter sizes refer to the outside
circumference of the catheter, not the luminal
diameter
• A, Conical tip
urethral catheter,
one eye. B, Robinson
urethral catheter. C,
Whistle-tip urethral
catheter. D, Coudé
hollow olive-tip
catheter. E, Malecot
self-retaining, four-
wing urethral
catheter. F, Malecot
self-retaining, two-
wing catheter. G,
Pezzer selfretaining
drain, open-end
head, used for
cystotomy drainage.
H, Foley-type balloon
catheter I, Foley-
type, three-way
balloon catheter
Difficult Catheterizations
• Difficulty in catheterizing the male patient can
result from a variety of causes.
• Inability to pass the S-shaped bulbar urethra and
resistance to catheter passage at the
bulbomembranous urethra with tightening of the
external sphincter are common.
• These problems are usually easily overcome with
a coudé catheter to negotiate the bulb or with
slow, gentle pressure to bypass the external
sphincter.
• Urethral strictures, prostatic enlargement, and
postsurgical bladder neck contractures can
make urethral catheterization difficult
• If one encounters difficulty passing a catheter,
it is wise to have a logical stepwise plan to
maximize the chances of success in
overcoming the difficulty
THANK YOU

Acute Urinary Retention

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ACUTE URINARY

Roheman, S.Kep, Ners, M.Kep

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