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HWN Suggests

Tasty Morsels of EM 041 – Acute Urinary Retention

The big take home should be this: you need to bloody well examine them. There is a real (and justifiable) desire to just slip in the catheter (or worse get someone else to do it) and get disposal nice and quickly. But as simple as most AUR is, you will miss important things (say spinal cord compression, or a penile tumour, especially in the patient with dementia or non-verbal patients) if you don’t physically get involved with the gorey details.

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Featured

  Priapism and Urinary Retention: Nuances in Management

While the diagnosis of urinary retention is usually straight forward, an important first step or cognitive forcing strategy is to consider the life- or limb-threatening etiologies such as cauda equina syndrome/spinal cord compression.

 Acute Urinary Retention in the Emergency Department

Up to 70% of men with acute urinary retention due to benign prostatic hypertrophy will have recurrence if the bladder is drained only during the ED visit and the catheter is removed prior to discharge.

 Doc I Can’t Pee, What Could It Be? Evaluation and Management of Acute Urinary Retention in the Emergency Department

There are numerous causes that lead to acute urinary retention. Its pathophysiology typically falls under the category of obstructive, inflammatory, infectious, neurologic, or pharmacologic related causes. The follow-up and treatment plan varies depending upon the underlying cause. In all cases, prompt and complete decompression of the bladder, commonly with a Foley catheter, is critical to reducing discomfort and long term morbidity for the patient

 Trial of void for acute urinary retention

A Trial of Void, also referred to as Trial Without Catheter, involves removal of the urethral catheter and an assessment of the patient’s ability to spontaneously urinate. If successful, the patient may avoid or delay surgical intervention and possibly be managed medically.

 Urinary Retention in Kids

It may be rare, but it does happen. As always, remain vigilant. Urinary retention is ominous. Don’t simply send the child home with a foley and a leg bag like you may do for the old gentleman with prostate problems.

Articles of Interest

An Unusual Cause of Acute Urinary Retention

Constipation is an atypical cause of acute urinary retention in adults and is rarely mentioned in the literature.

Approach to Urinary Retention in the Emergency Department

Medical history should include inquiry into neurologic, infectious, medication as well as structural etiologies for retention

Evaluation and Treatment of Acute Urinary Retention

Acute obstruction of urinary outflow is most often the result of physical blockages or by urinary retention caused by medications. The most common cause of acute urinary obstruction continues to be benign prostatic hypertrophy

Male Urinary Retention

Causes of urinary retention are numerous and categorized as obstructive, infectious, inflammatory, pharmacologic, neurologic, or other.

Suprapubic aspiration – when the catheter doesn’t cut it

It has been shown to have a significantly lower rate of contamination than TUC...

Urinary Retention in Children

The Pediatric Emergency Medicine Podcast is a brief review of the management of urinary retention in children. The most common causes are UTI and constipation – but you must be aware of neurological problems and assure that you history is thorough and your physical exam complete.

Urinary Retention: Rapid Drainage or Gradual Drainage to Avoid Complications?

Clinical Take Home Point: Rapid drainage of the bladder in urinary retention does not cause more hematuria requiring intervention, renal failure, or hemodynamic collapse compared to gradual drainage of the bladder.

Resources

Emergency Medicine Guidewire

Issues must be considered and some strategies to help you manage the patient with acute urinary retention in your Emergency Department.