URINARY RETENTION
• Defined as “inability to pass urine despite persistent effort”,
or, “inability to spontaneously empty the urinary bladder”.
• Urinary bladder has capacity of storing approximately 500
ml of urine.
• Overstretching of the bladder wall will cause muscular
ischemia and reduced sensation and contractility.
• The two main functions of lower urinary tract are urinary
storage and emptying.
• Mediated by complex neural circuits in central and
• Thus factors affecting micturition reflex, those which over
distend the bladder, or compromise the outflow will lead to
retention of urine.
• Various risk factors known for urinary retention are
Clinical features
• Urinary retention can be acute or chronic
Acute retention of urine :
Painful inability to pass urine with relief of pain on
catheterisation
Patient will have increased desire to pass urine
Commonly seen in urethral trauma, because of
anesthesia, post surgery (perineal or abdominal) etc.
Chronic retention of urine :
Painless, elevated residual volume after passing urine.
Usually seen in elderly and due to ineffective emptying
of bladder.
Becomes painful when infected.
Common condition – BPH.
• Pre and Post void residual urine ??
• Lower abdominal fullness
• Suprapubic pain or discomfort
• O/E : palpable bladder in lower abdomen, +/- tender
• +/- Overflow incontinence
• Massively distended bladder can stimulate vasovagal
reflex causing cardiovascular symptoms like
bradycardia, arrhythmia, hypotension or asystole.
If untreated ??
• UTI sets in and increases morbidity
• Chronic retention may lead to detrusor damage and
cause long term complications like bladder stone
formation, hydronephrosis, incontinence or renal
insufficiency.
Prevention –
• Careful evaluation of risk factors
• Minimizing damge during surgery
• Pain control and fluid administration
• Monitoring urinary output postoperatively.
Normally expected duration after which a patient should
void post surgery is 6 to 8 hours.
Management
• Immediate treatment for any type of retention is urinary
catheterisation followed by treating the cause.
• Ultrasound is done if postoperative retention is
suspected and if bladder volume is >=500ml,
catheterisation should be done.
• In chronic retention, “post obstructive diuresis” is seen -
>200ml urine per hour for 3 consecutive hours, it
requires :
Postural blood pressure checks
Fluid balance
Daily serum electrolyte monitoring
• If neurogenic bladder is suspected, intermittent
catheterisation is advised.
URINARY CATHETERISATION
• Two types of urinary catheristion is known to be done :
Urethral
Suprapubic
• Two types of catheters :
Based on composition
Latex coated
Silicone
Based on number of channels
Single channel
‘Two way’
‘Three way’
Based on size (french scale - Fr)
Thank you
