Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Acute Urinary Retention |Chronic Urinary Retention |Urinary Catheterisation
| Unable to Pass Urine + Bladder Scan > 500 mL or patient distressed/uncomfortable e.g. at 300-400 mls | |
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| 1 | Encourage voiding in toilet/commode if safe 🚽 (privacy, running tap water, warm bath). |
| 2 | If fails → insert urethral catheter. If difficult despite senior help ➡️ call urology. |
| 3 | Start Tamsulosin 400 mcg OD × 48h, then attempt TWOC. ⚠️ Warn about postural hypotension. |
| 4 | If BPH with large prostate (raised PSA, LUTS) → consider Finasteride 5 mg OD (slow onset). |
| 5 | Look for reversible causes: delirium, AKI, constipation, UTI, pain, immobility. |
| 6 | Chronic painless retention (>1 L) → refer urology, often managed outpatient. |
| Feature | Acute 🚨 | Chronic 🕐 |
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| Onset | Sudden (hours) | Gradual (weeks–months) |
| Symptoms | Painful, inability to void | Painless, overflow incontinence |
| Bladder | Tense, tender, distended | Very large, non-tender |
| Renal risk | AKI if untreated | Hydronephrosis, CKD |
| Causes | BPH, stone, stricture, drugs | Long BPH, neurogenic bladder |
| Catheterisation | Immediate relief | Less urgent; ISC/SPC often |
| Investigations | Bladder scan >500 ml, U&Es, PSA | USS bladder/kidneys, cystoscopy |
| Management | Immediate catheter, α-blocker, TWOC | α-blocker ± 5ARI, ISC/SPC, surgery |
| Complications | Pain, rupture, AKI | UTIs, stones, renal impairment |