Acute urinary retention and urinary incontinence

AUR is a commonly seen genitourinary emergency. It has many etiologies, including obstructive, neurogenic, pharmacologic, and extraurinary causes. Treatment is immediate bladder decompression by transurethral catheterization and treatment of the provoking etiology. Urinary incontinence is less commonly seen as a presenting complaint in the ED. For the emergency physician, the key lies in recognizing its underlying cause. Neurologic and pharmacologic causes need to be considered in all patients. Urinary incontinence that is not caused by a neurologic emergency can be referred for further outpatient evaluation.     

Acute urinary retention due to ectopic pregnancy

Two cases of ectopic pregnancy are presented in which acute urinary retention was a salient clinical feature. The emergency physician must consider ectopic pregnancy in the differential diagnosis in any woman of child-bearing age with abdominal, pelvic, or urinary complaints.     

Acute urinary retention attributable to sacral herpes zoster

Acute urinary retention in women is uncommon. A 63 year old woman presented with suprapubic pain, a palpable bladder, and multiple grouped vesicles on the right buttock. Catheterisation showed a residual of 2000 ml. A case is reported of acute urinary retention secondary to herpes zoster infection of the sacral nerves (S2-4).     

Acute urinary retention: developing an A&E management pathway

Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalisation, catheterisation and often surgery (Kirby, 1998). AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. The management of AUR is highly dependent on the cause, mainly BPH and clot/haematuria. Medical management will often necessitate the insertion of a urinary catheter, a procedure which is associated with an increased risk of urinary tract infections (Mulhall et al, 1998). The use of alpha-adrenegic antagonists (alpha-blockers), 5-alpha-reductase inhibitors, a trial without catheter and the catheter valve are recommended to delay or prevent the need for surgery and future complications. Proper assessment and documentation, particularly in relation to the catheterisation process is of vital importance. The authors demonstrate how audit was used in the development of a management pathway to provide guidance to accident and emergency (A&E) practitioners in their delivery of care to patients who presented to the A&E with AUR.     

Acute urinary retention secondary to an incarcerated gravid uterus

Acute urinary retention has many etiologies. In the pregnant patient, especially at the end of the first trimester, an incarcerated gravid uterus is a rare but possible cause. The patient discussed is a 30-year-old, gravida 4, para 2012, woman who was 14 weeks pregnant and who presented complaining of lower abdominal pain, urinary frequency, urgency, and nocturia. Based on the patient's symptoms, a diagnosis of a urinary tract infection was made, and antibiotic therapy was begun. Her symptoms failed to resolve, however, and she was referred for further evaluation, which eventually revealed an incarcerated gravid uterus. The patient was referred to an obstetrician who re-positioned her uterus without difficulty, and she subsequently had an uneventful pregnancy.     

Acute urinary retention by fungus balls of Candida

In the cases of rapid obstruction of urethral catheter, resulting in urinary retention, due to excessive floating material, such as a large number of spherical masses, fungus balls of Candida may be present.     

Acute urinary retention secondary to perforated diverticulitis misdiagnosed as acute prostatitis

Abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. Our patient is the first case to be reported. Because of the atypical presentation, he was initially misdiagnosed and treated as having acute prostatitis. Emergency physicians should have a high index of suspicion. Detailed history, abdominal sonography, and digital examination are helpful in diagnosing this disease.     

Acute, transient urinary retention from combined ecstasy and methamphetamine use

Methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") are synthetic amphetamine analogs that have become increasingly popular, particularly among adolescents and young adults. Many deleterious physiologic effects arising from the use of these agents have been well documented in the medical literature. Urinary retention, however, has rarely been reported as an effect of MDMA or methamphetamine use and is thought to occur as a result of alpha-adrenoceptor stimulation of the bladder neck. We report a case of acute, transient urinary retention due to combined MDMA and methamphetamine use with laboratory confirmation.     

Acute urinary retention: causes, clinical features and patient care

This article provides an overview of acute urinary retention (AUR), which can cause patients severe pain and distress. It examines potential causes and risk factors. The main strategies for the treatment and clinical management of patients are discussed. Nurses have a key role in identifying patients at risk of AUR. Therefore, the nursing role in assessment and management is explored.     

Management of urinary retention

An inability to void urine from the bladder is described as retention of urine. It is not uncommon after surgical procedures or childbirth but is usually temporary. It also occurs as a result of obstruction or of a neurological disease such as multiple sclerosis (Getliffe and Dolman, 2003).     

Acute urinary retention in the first and second-trimester of pregnancy: Three case reports

BACKGROUNDAcute urinary retention (AUR) is rare during pregnancy. CASE SUMMARYWe report on three pregnant women with AUR between the 10^th and 18^th wk of gestation. Case 1 was first diagnosed as urinary tract infection and developed a urinary tract infection due to urinary retention caused by urethral obstruction. Case 2 had a history of previous abdominal surgery for pelvic tuberculosis, leading to severe adhesions and a persistent retroverted uterus. In case 3, healthcare providers focused on the patient’s gastrointestinal symptoms and did not investigate her inability to void. Case 1 required manual disimpaction of the uterus and the knee-chest position. The other cases required immediate catheterization. The condition resolved in cases 1 and 2; these patients had normal pregnancies. Case 3 had severe complications at the time of consultation, leading to an abortion. CONCLUSIONRetroverted uterus is the most common cause of AUR. Prompt recognition and diagnosis are required. Clinicians should be aware of the risk factors, etiology, and clinical presentation of AUR in the first and second trimester of pregnancy.     

Management of postoperative urinary retention

Clinical governance has been described as 'the total of all factors that make the National Health Service, and the place in which you work, safe (Lilley, 1999). The term 'clinical governance' was used for the first time in the White Paper, The New NHS: modern, dependable (DoH, 1997), in which the government stated its commitment to giving the people of the United Kingdom a quality health service. Clinical governance is the framework for driving this quality service. It encompasses clinical effectiveness, risk management, fitness to practise and a patient-focused culture, all of which are underpinned by an organisation that supports the ethos.     

Acute urinary retention in a 9-year-old child: an atypical presentation of acute appendicitis

Acute urinary retention is unusual in childhood and when present is likely to have an identifiable cause. Although the evaluation is often performed by the urologic specialist after relief of the obstruction, it is imperative that some causes be identified in the Emergency Department. This is a case of a 9-year-old boy in acute urinary retention caused by a ruptured appendix with a periappendiceal abscess.