Chronic urinary retention and its management

Chronic retention differs from acute retention in that the distention of the bladder is almost painless. These patients are at risk of upper tract dilatation because of the high intravesicular tension due to large residual urine and the high resting bladder pressure. Men with chronic retention owing to bladder outlet obstruction require urgent referral for prostatectomy.

Those with a serum creatinine level greater than 2mg% are at risk of developing a post-obstruction diuresis following catheterisation and may need careful monitoring with replacement of inappropriate losses by intravenous saline; they are also at risk of haematuria as the previously distended urinary tract sudden shrinks.

Slow decompression by means of intermittent spigotting of the catheter does not prevent haematuria.

 

Retention with Overflow

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In this condition, the patient has no control of his or her urine, small amounts passing involuntarily from time to time from a distended bladder. It may follow a neglected acute retention or chronic retention.  Retention with overflow is referred to as “incontinence”.  The general principles, which govern the treatment of this condition are similar to those of acute retention.

 

Complications

  • Stagnation of urine leads to infection.
  • If both kidneys are affected, the result may be renal insufficiency.
  • Pyonephrosis is the end result of a severely infected and obstructed kidney.

Treatment

  • Treatment of the cause.
  • Broad-spectrum antibiotic

e.g. ofloxacin, ciprofloxacin should be given for the eradication of the infection.

 

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