This MedLibrary.org supplementary page on Ischuria is provided directly from the open source Wikipedia as a service to our readers. Please see the note below on authorship of this content, as well as the Wikipedia usage guidelines. To search for other content from our encyclopedia supplement, please use the form below:
Related Sponsors
| ICD-10 | R33. |
|---|---|
| ICD-9 | 788.5 |
 |
This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed. (June 2008) |
Urinary retention also known as ischuria is a lack of ability to urinate. It is a common complication of benign prostatic hypertrophy (also known as benign prostatic hyperplasia or BPH), although anticholinergics may also play a role, and requires a catheter or Prostatic stent. Various medications (e.g. some antidepressants) and recreational use of amphetamines and opiates are notorious for this.
Contents |
Signs and symptoms
Urinary retention is characterised by poor urinary stream with intermittent flow, straining, a sense of incomplete voiding and hesitancy (a delay between trying to urinate and the flow actually beginning). As the bladder remains full, it may lead to incontinence, nocturia (need to urinate at night) and high frequency. Acute retention caused by complete anuria is a medical emergency, as the bladder may distend (stretch) to enormous sizes and possibly tear if not dealt with quickly. If the bladder distends enough it will begin to become painful. The increase in pressure in the bladder can also prevent urine entering from the ureters or even cause urine to pass back up the ureters and get into the kidneys, causing hydronephrosis, and possibly pyonephrosis, kidney failure and sepsis. A person should go straight to an emergency department as soon as possible if unable to urinate when having a painfully full bladder.
In the longer term, obstruction of the urinary tract may cause:
- Bladder stones
- Loss of detrusor muscle tone (atonic bladder is an extreme form)
- Hydronephrosis (congestion of the kidneys)
- Hypertrophy of detrusor muscle
- Diverticula in the bladder wall (leads to stones and infection)
Causes
In the bladder
- Detrusor sphincter dyssynergia
- Neurogenic bladder (commonly saccral nerve damage, demyelinating diseases or Parkinson's disease)
- Iatrogenic scarring of the bladder neck (commonly from removal of indwelling catheters or cystoscopy operations)
- Damage to the bladder
In the prostate
- Benign prostatic hyperplasia
- Prostate cancer and other pelvic malignancies
- Prostatitis
Penile urethra
- Congenital urethral valves
- Phimosis or pinhole meatus
- Circumcision
- Obstruction in the urethra, for example a metastasis or a precipitated pseudogout crystal in the urine
- STD lesions (gonorrhoea causes numerous strictures, leading to a "rosary bead" appearance, whereas chlamydia usually causes a single stricture)
Other
- Paruresis ("shy bladder syndrome")- in extreme cases, urinary retention can result
- Consumption of some psychoactive substances, mainly stimulants, such as Ecstasy.
- Use of drugs with anticholinergic properties.
- Stones or metastases can theoretically appear anywhere along the urinary tract, but vary in frequency depending on anatomy
Paruresis, inability to urinate in the presence of others (such as in a public restroom), may also be classified as a type of urinary retention, although it is psychological rather than physiological.
Diagnostic tests
Urine flow tests may aid in establishing the type of micturition abnormality. Common findings include a slow rate of flow, intermittent flow and a large post void residual, determined by ultrasound of the bladder. In chronic retention, ultrasound of the bladder may show massive increase in bladder capacity (normal capacity being 400-600 ml).
Determination of the serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate cancer, though this is also raised in BPH and prostatitis. A TRUS biopsy of the prostate (trans-rectal ultra-sound guided) can distinguish between these prostate conditions. Serum urea and creatinine determinations may be necessary to rule out backflow kidney damage. Cystoscopy may be needed to explore the urinary passage and rule out blockages
Treatment
In acute urinary retention, urinary catheterization, placement of a Prostatic stent or suprapubic cystostomy instantly relieves the retention. In the longer term, treatment depends on the cause. Benign prostatic hypertrophy may respond to alpha blocker and 5-alpha-reductase inhibitor therapy, or surgically with prostatectomy or transurethral resection of the prostate (TURP).
See also
- Constipation, inability to defecate
- Urinary incontinence, inability to hold the urine
References
|
|||||||||||
Wikipedia content modification information:
- This page was last modified on 28 November 2008, at 00:27.
Wikipedia Authorship and Review
Wikipedia content provided here is not reviewed directly by MedLibrary.org. Wikipedia content is authored by an open community of volunteers and is not produced by or in any way affiliated with MedLibrary.org.
Wikipedia Usage Guidelines
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article on "Ischuria".
The URL for this specific entry is:
All Wikipedia text is available under the terms of the GNU Free Documentation License. (See Copyrights for details). Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc.