Infections of the Urinary Tract
Keith Struthers in Clinical Microbiology, 2017
Insertion of a urinary catheter breaches the normal defences of the bladder and urethra, and the majority of patients with a long-term catheter will develop asymptomatic colonization (bacteriuria). There is a risk of a catheter-associated UTI, with bacteraemia and sepsis. The decision to insert a long-term catheter has to be based on clear clinical need, including: Acute and chronic urinary retention.Bladder outlet obstruction.Selected perioperative patients.To accurately monitor urine output in the critically ill patient.To assist healing of pressure sores in incontinent patients.For the management of long-term incontinence in selected patients as a last resort after underlying causes have been assessed and addressed.
Endocrinology and gonads
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
11.28. Adherent labia minorausually indicate an underlying vaginal atresia.can cause acute urinary retention.can be treated by the application of an oestrogen cream.require reconstructive surgery for the girl to conceive normally.are rarely associated with urogenital problems.
Peri-operative medicine
Henry J. Woodford in Essential Geriatrics, 2022
Abdominal pain accounts for approximately 3–6% of emergency department (ED) visits in people aged over 65 years.38,39 Around 10–37% will require acute surgical intervention.39–43 Older people presenting with abdominal pain have higher rates of surgery and mortality than younger people.44 They can be a challenging group to assess.5,45 It should be remembered that abdominal pain can occasionally be the presenting complaint for non-abdominal disorders (e.g. myocardial infarction). Urinary retention should also be considered, especially in older men.
Acute urinary retention after alprazolam use: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2018
Demet Saglam Aykut, R. A. Emel Uysal
Urinary retention is a condition in which impaired emptying of the bladder results in postvoid residual urine. It is generally classified into “acute” or “chronic” urinary retention [1,2]. Chronic urinary retention develops over a long period with development of a painless, palpable bladder due to a postvoid residual volume. Acute urinary retention is defined as the loss of ability to micturate. The retention itself is often painful, the onset is acute and it requires treatment by urinary catheterization. Risk factors are increasing age and urological conditions such as benign prostatic hyperplasia (BPH), prostate cancer, urethral stricture, surgery, and the use of medications. Due to the mixed mechanism of the mixture, many drugs may interact with the pathway in different modes. Although the incidence of urinary retention, in particular acute urinary retention, has been well studied in observational studies and randomized controlled trials, data on the incidence of drug-induced urinary retention are scarce [3]. Observational studies suggest that up to 10% of episodes might be attributable to the use of concomitant medication. Urinary retention has been described with the use of drugs with anticholinergic activity (e.g. antipsychotic drugs, atropine, antispasmodics and anticholinergic respiratory agents), antidepressant agents, alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, opioids and anaesthetics, calcium channel antagonists, and detrusor relaxants. In this article, a case of acute urinary retention developed after the use of alprazolam was discussed.
The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review
Published in The Aging Male, 2020
Anton Wong, Wasim Mahmalji
The results indicate that this is an effective approach in treating patients with acute urinary retention. There was a 100% success rate for patients passing their TWOC. All patients that were recruited had initially failed their TWOC, and our follow up revealed that all patients are catheter free after the procedure. 70% of patients passed their first TWOC at 4 weeks and 30% passed the second TWOC at 6 weeks. The mean TRUS volume had also decreased after intervention (73.8 cc and 41.5 cc respectively). This meant that there was an average of 43.8% decrease in TRUS volume after the procedure. Post-operative PSA value also fell by 52.5%. All patients were satisfied with the functional outcomes as their mean QoL score after the treatment was 0.7. On average, the patients had a satisfactory mean Qmax score of 13.7 after the procedure considering the mean age of 75. Finally, the mean PVR volume was significantly reduced to 107.2mls compared to the mean 1100 ml residual volume before treatment.
The Cauda Scale – Validation for Clinical Practice
Published in British Journal of Neurosurgery, 2020
Michelle Angus, Andrew Berg, Roberto Carrasco, Daniel Horner, John Leach, Irfan Siddique
It has been shown retrospectively that bladder function post decompression can improve at long term follow up, especially if decompression is performed prior to development of CES-R.7,11 Prioritisation is therefore required, especially where there is limited access to MRI and where patients may need to be transferred to tertiary centres out of traditional working hours. A system such as TCS for identifying patients with potential CES and prioritising them is very much desired. TCS recommends that those with signs of CES (T0 or 1, S0 or 1, B0 (possibly B1-3) require MR imaging on an emergency basis. Patients with TCS 9/9 do not require urgent/emergency imaging, yet 9 of the patients in this study with a TCS 9/9 had CES and went on to have urgent decompression with no neurological deficit on discharge due to the early diagnosis and intervention. TCS recommends that patients with subjective symptoms but no objective signs (B1, 2 or 3, S2 or 3, T2) do not require emergency imaging; their priority for MR imaging will be determined by the totality of the clinical picture. This would again prevent the early confirmation of CES found in the majority of our cohort of patients. By the time classic signs such as urinary retention have developed, neurological damage may be irreversible. Hence a move to describe the more classical neurological features as ‘white flags’ and focus only on those features suggesting impending damage still amenable to intervention as true ‘red flags’.10 This move is not reflected in TCS which is heavily weighted to traditional objective clinical findings.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Bladder
- Bladder Stone
- Constipation
- Cystocele
- Urinary Incontinence
- Urinary Tract Infection
- Neoplasm
- Urethra
- Urethral Stricture