Urinary retention, urinary retention, ischuria lat. = Retentio urinaeEngl. = retention of urine
Urinary retention is first diagnosed by means of a medical history and physical examination, whereby attention is paid to abdominal (through the abdomen) and rectal (through the rectum) palpability of the bladder.
These examinations are supported by sonography (ultrasound), which reveals a bulging bladder if urinary retention is present. Furthermore, blood and urine tests contribute to the diagnosis “urinary retention” and an excretion urogram can be prepared for radiological measurement of urine excretion in the draining urinary tract. In the acute emergency situation of urinary retention, the bladder is emptied via a urethral catheter.
This emptying is fractionated, i.e. in several small quantities, in order to prevent injury to the venous vessels overstretched with the bladder. As an alternative to catheter placement, the bladder can also be punctured through the abdominal wall (suprapubic) above the pubic bone to relieve the pressure and thus eliminate urine. If the cause is a tamponade of the bladder, the blood coagulum is removed with the help of a cystoscope, an endoscopic device for viewing the urethra and the bladder, which is advanced through the urethra into the bladder.
Mechanical constrictions, a traumatic urethral rupture or a descensus lowering of the uterus, on the other hand, are treated surgically. Drugs that cause urinary retention are discontinued or reduced completely. Post-operative urinary retention usually recedes of its own accord; this can be supported by early mobilization of the patient after the operation or administration of medication.
Otherwise, the underlying disease associated with the urinary retention is treated. If the urinary retention is not treated in time, various complications can occur. On the one hand, the acute urinary retention can turn into a persistent chronic one and lead to a urinary congestion kidney.
This develops from the lack of emptying of the bladder. The urine cannot flow off and instead accumulates in the opposite direction through the ureter and back into the kidney. On the other hand, incontinence can occur in the course of urine retention.
Due to the congested urine in the bladder, the pressure there increases until the urine is involuntarily drained and a so-called overflow incontinence develops. The complications of urinary retention also include urinary tract infections. Since the urine is not excreted, there is a certain lack of flushing of the urinary tract, so that germs from outside can rise through the urethra and cause an infection.
The prognosis depends on the underlying disease. Depending on whether the cause can be eliminated or not, urinary retention may occur again.
