Urinary Retention

Subject: Medical and Surgical Nursing I (Theory)

Overview

Another name for urinary retention is ischuria. It denotes a difficulty to completely empty the bladder. Its causes include pelvic trauma and damage, tethered spinal cord syndrome, chronic constipation, accidents, etc. Its risk factors include drinking alcohol, renal stones, prostate cancer, and pregnant women. Urinary incontinence, nocturia, etc. are some of its symptoms. It is treated with direutics, IV drip, analgesics for discomfort, antibiotics, etc. The surgical procedures used for it are cystoscopy, catheter insertion, and trans-urethral prostate resection. keep your electrolyte balance. Infection prevention must be strictly followed. Serious side effects like renal calculi, pyleonephritis, sepsis, or hydronephrosis may result from it.

Urinary Retention

Anatomy and Physiology

  • The kidneys discharge urine, which is then collected by the bladder.
  • On the pelvic floor, it rests.
  • Its muscles are stretchy.
  • It stands between the uterus and the rectum.
  • It functions as a transient urine reservoir and disperses urine across the urethra.
  • The bladder is compressed by the larger uterus during pregnancy.
  • That results in an irregular bladder posture,
  • The ureter, renal pelvis, and calyces are all enlarged.
  • The ureter kinked up,
  • Kidney is 1 cm larger,
  • An increase in renal plasma flow of 50% to 75% occurs.
  • Marked hypertrophy of the bladder wall's muscle and elastic tissue due to congestion.

Introduction

  • Another name for urinary retention is ischuria.
  • It denotes a difficulty to completely empty the bladder.
  • An improper bladder posture results from the uterus' increased size pressing on the bladder during pregnancy.
  • Insidious urine retention is another name for postpartum urinary retention.
  • Urinary retention following a vaginal birth is quite typical.
  • Absence of spontaneous micturation within 6 hours following vaginal birth is the traditional definition of postpartum urine retention.
  • It might be acute or persistent,

Causes

  • Nerve dysfunctional,
  • Vaginal childbirth,
  • Pelvic injury or trauma,
  • Tethered spinal cord syndrome,
  • Chronic constipation,
  • Neurogenic bladder,
  • Latrogenic,
  • Obstruction in urethra,
  • Trauma/Accident.
  • Kidney stone.

Risk Factor

  • Prostate cancer,
  • Pregnant women,
  • History of kidney stones,
  • Infection of bladder,
  • Alcohol consumption,
  • Certain prescribed drugs ( albuterol, epinephrine),
  • Surgery(complication of anesthesia),
  • Prolonged exposure to cold temperature,
  • UTI(history).
  • Delaying urination for a long time.

Types

  • Acute Urinary Retention (for a short period of time).
  • Chronic Urinary Retention (for a long period of time).

Clinical Features

  • Poor urinary stream,
  • Urinary incontinence,
  • Nocturia,
  • Difficulty to urine,
  • Loss of small amount of urine during,
  • Inability to urinate fully,
  • Strained effort to push urine out.

Diagnostic Investigation

  • History taking,
  • Physical examination,
  • USG of bladder,
  • Prostate-specific antigen test,
  • MRI of lumbar spine,
  • Cystoscopy,
  • X-ray of abdomen,
  • Urology test.

Complications

Urine retention can lead to chronic infections like:

  • Renal calculi,
  • Pyelonephritis,
  • Sepsis or Hydronephrosis.

In addition, it can also leads to urine leakage which causes perineal skin breakdown, especially if hygiene measures are neglected.

  • Medical Management
    • Direutics,
    • IV drip,
    • Analgesics for pain,
    • Antibiotic.
  • Surgical Management
    • Catheter insertion,
    • Trans-urethral resection of prostate,
    • Cystoscopy.
  • Nursing Management
    • Pain management,
    • Wound dressing,
    • Catheter care,
    • Infection prevention,
    • Maintaining adequate perfusion,
    • Monitoring nutrition,
      • ( dietary supplement)
    • Managing fatigue,
    • Maintain fluid and electrolyte balance,
    • Support and provide emotional support.

References

  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013

     
Things to remember
  • The kidneys discharge urine, which is then collected by the bladder.
  • It functions as a transient urine reservoir and disperses urine across the urethra.
  • The bladder is compressed by the larger uterus during pregnancy.
  • There is a 1 cm increase in kidney size, a 50%–75% increase in renal plasma flow, and dilation of the ureter, renal pelvis, and calyces.
Questions and Answers
  • Another name for urinary retention is ischuria.
  • It denotes an inability to completely empty the bladder.
  • The bladder is compressed by the larger uterus during pregnancy, which leads to an irregular bladder posture.
  • Insidious urine retention is another name for postpartum urinary retention.
  • Urinary retention following a vaginal delivery is quite typical.
  • After a vaginal delivery, postpartum urinary retention is traditionally defined as the absence of spontaneous micturation within 6 hours.
  • It could be acute or persistent,

Causes

  • Disorder of the nerves
  • Vaginal delivery
  • Pelvic injury or trauma
  • Spinal cord tethering syndrome
  • Constipation in chorinc
  • Neurogenic bladder
  • Latrogenic
  • Uretharal obstruction
  • Trauma\Accident
  • Renal stone

Risk Factors

  • Breast cancer
  • Expecting mothers
  • Kidney stone history
  • Bladder infection
  • Alcoholic beverages
  • A few prescription medications ( albuterol, epinephrine)
  • Surgery(complication of anesthesia) (complication of anesthesia)
  • Enduring a frigid temperature for a long time
  • UTI(history)
  • Long-term delaying of urinating

Types

  • Acute urinary incontinence (for a short period of time)
  • Chronic retention of urine (for a long period of time)

Clinical Features

  • Sluggish urinary steam
  • Incontinence of the urine
  • Nocturia
  • A challenge to urinate
  • Pee loss that isn't too significant during the day
  • Inability to adequately urinate
  • Strained attempt to remove urine

Introduction

  • Another name for urinary retention is ischuria.
  • It denotes an inability to completely empty the bladder.
  • The bladder is compressed by the larger uterus during pregnancy, which leads to an irregular bladder posture.
  • Insidious urine retention is another name for postpartum urinary retention.
  • Urinary retention following a vaginal delivery is quite typical.
  • After a vaginal delivery, postpartum urinary retention is traditionally defined as the absence of spontaneous micturation within 6 hours.
  • It could be acute or persistent,

Causes

  • Disorder of the nerves.
  • Vaginal delivery.
  • Pelvic injury or trauma.
  • Spinal cord tethering syndrome.
  • Chronic constipation.
  • Neurogenic bladder.
  • Latrogenic.
  • Urethral obstruction
  • Trauma\Accident.
  • Renal stone

Risk Factor

  • Breast cancer
  • Expecting mothers
  • Kidney stone history
  • Bladder infection
  • Alcoholic beverages
  • A few prescription medications ( albuterol, epinephrine)
  • Surgery(complication of anesthesia)
  • Enduring a cold temperature for a long time
  • UTI(history)
  • Long-term delaying of urination

Types

  • Acute urinary incontinence (for a short period of time)
  • Chronic retention of urine (for a long period of time)

Clinical Features

  • Sluggish urinary steam
  • Incontinence of the urine
  • Nocturia
  • A challenge to urinate
  • Pee loss that isn't too significant during the day
  • Inability to adequately urinate
  • Strained attempt to remove urine

Diagnostic Investigation

  • Making history
  • Examination of the body
  • A bladder USG
  • Test for prostate-specific antigen
  • MRI of the lower back
  • Cystoscopy
  • Abdomen X-ray
  • A urology exam

Complication

Chronic infections like: Urinary retention can result in:

  • kidney calculi
  • Pyleonephririts.
  • Hydronephrosis or sepsis.

Additionally, if hygiene precautions are skipped, it can also result in urine leakage, which damages the perineal skin.

Medical Management

  • IV drip
  • Direutics
  • Drugs that relieve discomfort
  • Antibiotic

Surgical Management

  • Inserting a catheter
  • Prostate removed via the urethra
  • Cystoscopy

Nursing Management

  • Management of pain
  • Dressing a wound
  • Care for catheters
  • Prevention of infection
  • Preserving a sufficient perfusion
  • Observing the diet
  • Nutritional supplement
  • Managing tiredness
  • Ensure proper electrolyte and fluid balance
  • Encouragement and emotional support

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