Post void residual urine in female8/28/2023 ![]() ![]() Patients with long-standing significant urinary retention may have a palpable enlarged bladder, which will usually be non-tender.Abdominal and genitourinary examination:.Check blood pressure as a possible indicator of renal impairment.Lethargy, pruritus, recurrent infections, hypertension due to chronic kidney disease (rare with cases of mild-to-moderate obstructive uropathy).Increasing lower abdominal discomfort (may indicate intermittent acute-on-chronic-retention).Symptoms consistent with urinary tract infection.'Double' or recurrent voiding of urine (returning to micturition due to a sensation of 'needing to go again').A sensation of incomplete voiding after micturition.The symptoms, if any are present, usually come on slowly and may not be noticed due to their gradual evolution. The cause of urinary retention in women is unknown in about a third of cases but approximately half are due to Fowler's syndrome (typically seen in women in their 20s-30s and thought to be due to failure of the urethral sphincter to relax appropriately).Over 40% of men aged 50 years or more have moderate-to-severe LUTS but many do not seek medical help and simply put up with the problem. However, as they increase in severity, they have a significantly negative effect on quality of life. Experience of urinary storage or of voiding-related symptoms is very common in middle-aged to older men.Chronic urinary retention is largely a condition that affects men, as its most common cause is BPH however, there is an appreciable background incidence in women.Trauma - eg, fractured pelvis, iatrogenic.Meatal stenosis is a congenital disorder in boys. ![]() Secondary bladder neck obstruction due to deformity of the urethra (posterior urethral valves), leading to back pressure on voiding, and bladder neck hypertrophy.Primary bladder neck obstruction, unrelated to deformities of the urethra.Iatrogenic - eg, following colposuspension.Botulinum toxin (used to treat overactive bladder).Drugs causing bladder sphincter dysfunction include:.Prostatic carcinoma can obstruct the urethra either by a direct mass effect (as in BPH) or by invasion of the wall.Benign prostatic hyperplasia (BPH) is by far the most common cause and is a common sequelae of male ageing.Important causes of bladder outlet obstruction The most usual cause of chronic urinary retention is bladder outlet obstruction. This is in contrast to acute urinary retention, a medical emergency, which is painful and the patient is unable to urinate despite a full bladder.Ĭhronic urinary retention, whilst not immediately life-threatening, can lead to hydronephrosis and renal impairment and puts the patient at risk of acute-on-chronic retention, so requires diagnosis and treatment. Other patients with chronic urinary retention may be able to urinate but experience lower urinary tract symptoms (LUTS), related to storage and voiding difficulties. Some patients with chronic urinary retention do not have any symptoms. Urinary retention describes a bladder that does not empty completely or does not empty at all. See also the separate articles Benign Prostatic Hyperplasia, Urinary Tract Obstruction, Lower Urinary Tract Symptoms in Men, Lower Urinary Tract Symptoms in Women, Voiding Difficulties and Acute Urinary Retention. ![]()
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