ACUTE URINARY RETENTION

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ACUTE URINARY RETENTION

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ACUTE URINARY RETENTION :

1 ACUTE URINARY RETENTION Dr. Akhtar Nawaz PG-3 FCPS Urology PIMS, Islamabad

ANATOMY:

2 ANATOMY

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NERVE SUPPLY:

5 NERVE SUPPLY

PARASYMPATHETIC SUPPLY:

6 PARASYMPATHETIC SUPPLY Motor Anterior primary divisions of S 2-4 Fibres pass pelvic splanchnic nerves to inferior hypogatric plexus and thence to urinary bladder

SYMPATHETIC SUPPLY:

7 SYMPATHETIC SUPPLY Sensory T 11-12 And L 1-2 Fibres pass to presacral hypogastric nerves And sympathetic chains to inferior hypogastric plexus And thence to urinary bladder

SOMATIC SUPPLY:

8 SOMATIC SUPPLY Nerves pass through pudendal nerve And inferior hypogastric plexus to distal sphincter mechanism

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9 Afferent: Sympathetic Painful sensations when the bladder over distends Other afferents Mucosa: Touch, temperature and pain Muscle and lamina propria: stretch Efferent: Pelvic Parasympathetic

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PHYSIOLOGY:

12 PHYSIOLOGY Coordinated in pons (Midbrain) Detrusor contractions are coordinated with inhibition of distal sphincter mechanism Pathway interruption => Active detrusor +Active sphincter => Detrusor Sphincter Dyssynergia

CAUSES OF RETENTION:

13 CAUSES OF RETENTION

MALE:

14 MALE Bladder outflow obstruction Post operative Infection phimosis

FEMALE:

15 FEMALE Retroverted gravid uterus Multiple sclerosis

COMMON TO BOTH GENDERS:

16 COMMON TO BOTH GENDERS Clot retention Urethral calculus Urethral trauma Neurogenic Fecal impaction Infection Anal pain Drugs Anti histaminics Anti cholinergics Anti HTNsives TCAs Spinal anaesthesia Ageing (Sm. Msl dysfunction)

DIAGNOSIS:

17 DIAGNOSIS No urine passed for hours Visible bladder with tender palpation and dull + tender percussion Prolapsed disc with cauda aquina => Reflexes and perianal sensations

SPECIFIC FEATURES:

18 SPECIFIC FEATURES Age Trauma LUTS examination

INVESTIGATIONS:

19 INVESTIGATIONS Urine R/E X-ray KUB Renal stones Ureteric stones Bladder stones Urethral stones Bladder shadow Pelvic bones Spine

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20 USG Bladder over distention Prostate with retrograde effects Bladder tumour Clots Stone disease Retrograde Urethrogram

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21 Antegrade urethrogram Urodynamic studies

MANAGEMENT:

22 MANAGEMENT Emergency treatment Conservative Precipitating cause Pain killers Mobilization Social environment Water tap Warm bath Urethral catheterization Percutaneous suprapubic catheterization

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23 Definitive treatment Infection Stones Stricture Prostate Neurogenic

THANK YOU:

24 THANK YOU

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