In the case of urinary retention, two very different pathologies can be distinguished according to whether it is a one-time urine retention, or chronic urinary retention
. Acute urinary retention (AUR) is experienced as an individual's inability to urinate even though the bladder is full. Acute urinary retention is different from anuria, which is the non arrival of urine to the bladder, often a disorder of renal origin. Urine retained puts tension on the urinary tract and causes pain. The AUR can be caused by a mechanical cause such as an obstacle in the urinary tract, by the use of certain medications or by a neurological disease. In addition, there is chronic urine retention (CUR): it manifests itself as an incomplete emptying of the bladder with remaining urine residue.
Symptoms of acute urine retention are:
- severe pain in the lower abdomen;
- an increase in the volume of the bladder, as identified by a non-movable mass above the pubis,;
- a general state of agitation and anxiety often present because of the intensity of pain and the inability to urinate;
- a lack of issuance of urine for several hours.
The diagnosis of acute retention of urine is performed by a physical examination in which the doctor detects a mass located above the pubis. A complete rectal examination may be performed. Once the diagnosis is made clinically, the origin of the AUR will be sought secondarily. The priority remains to relieve the patient. In case of doubt, a bladder ultrasound will confirm the diagnosis. An assessment will be made after voiding, consisting of a urinalysis, urine cytology examination, a blood test with analysis of renal function by measuring creatinine and a calculation of glomerular filtration. In men, specific prostate antigen levels will also be measured.
Acute urinary retention is treated by the emergency evacuation of urine from the bladder. Two techniques are possible. Usually in women, it consists of urinary catheterization by inserting a catheter into the urethra. This is however impossible to perform in some cases, namely in men with suspected prostatitis. The second technique preferably used in men is the suprapubic catheterization where a needle is inserted through the abdomen into the bladder. The latter also has counter-indications such as the use of blood thinning medication, or the presence of hematuria, blood in the urine.
Original article published by
. Translated by Jeff