Acute urinary retention occurs as a result of compression of the urinary tract (adenoma or prostate cancer, cicatricial stricture of the urethra, prostatitis) with a decrease in the contractility of the muscular wall of the bladder. With prostate adenoma I - II degree, acute urinary retention is facilitated by pelvic organ goperemia (alcohol consumption, hypothermia, overwork, prolonged urinary retention, prolonged sitting or lying down), less often - the appointment of diuretics. Any of these predisposing factors leads to overdistension of the bladder and loss of detrusor function.
Code according to the international classification of diseases ICD-10:
- R33- Urinary retention
Symptoms, course
Pain in the lower abdomen, urge to urinate. On palpation above the pubis, a pear-shaped, slightly painful formation of a densely elastic consistency is determined.Urinary retention: Diagnosis
Diagnosis
specified during catheterization of the bladder.Urinary Retention: Treatment Methods
Treatment
Single or permanent catheterization of the bladder until the restoration of its function. After the elimination of acute urinary retention, it is necessary to examine the patient and treat the underlying disease that led to its development.Complications
catheterization: damage to the wall of the urethra, acute orchiepididymitis, urinary tract infection.Forecast
depends on the underlying disease.Diagnosis code according to ICD-10. R33
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The disease code for microbial 10 is an urgent process, with a characteristic blockage in the removal of urine from an overfilled urea. Such discomfort is manifested in various diseases. The international classification of this pathology has its own code number 33.
Urinary retention according to microbial 10 is detected in the diagnosis of a patient who has not previously experienced such urinary disorders. Features of the anatomical structure of the male urethra explain the frequent manifestation of the disease in the male half. With this classifier No. 33, urgent medical assistance is needed to prevent rupture of the urea, injury to the kidneys, and manifestations of other rather dangerous pathologies.
The clinical picture of acute urinary retention
The disease has certain developmental factors. This condition can be observed in males and females. Women rarely experience this problem. The female body reacts with an acute retention of urine to the process of a tumor neoplasm in the female reproductive system. This is due to mechanical squeezing, which leads to urinary retention.
Difficulties urinating in women occur while carrying a child (pregnancy) and when the urinary tract is lowered.
Factors leading to urinary retention in the male half have their own characteristics.
Among them, the most common are:
stressful situations
- failure of the central nervous system;
- prostate adenoma (hyperplasia);
- urolithiasis;
- sclerosis of the cervical region of the urea;
- the occurrence of neoplasms;
- blood clots;
- severe intoxication;
- depression, stress;
- acute prostatitis.
Ischuria (impaired outflow of urine) can occur as a result of infection entering the genitourinary system. Sometimes this pathology can develop as a complication after surgery on the rectum and neighboring organs of the small pelvis.
Boys or adolescents experience this pathology with an acute violation of urinary emission. For example, phimosis (narrowed condition of the flesh). At a young age in girls, as in adolescence, blocking the outflow of urine occurs very rarely. Most often, if this happens, it is due to systemic pathology inside the body.
Mkb 10 ischuria - according to international qualifications, it does not attach importance to the causes of the appearance of pathology in men and women.
Symptomatic manifestation
The pathological process of removing urine from the urea is usually accompanied by painful symptoms, to which it is impossible not to respond. The main manifestation of the disorder is acute, unbearable pain. Men often feel pain in the penis.
Incontinence, frequent urges to go to the toilet are added to all the unpleasant sensations, but it does not go out in full, and sometimes it does not work at all. Unsuccessful attempts result in increased pain.
Typical signs of the development of acute urination include:
Urine does not pass - growing anxiety;
- bloating of the abdominal cavity;
- irritation in the abdomen;
- decreased appetite;
- disturbed defecation;
- gag reflex with nausea;
- increased weakness;
- restless sleep;
- dizziness;
- flatulence;
- elevated temperature.
Sometimes there are manifestations of pain symptoms in the lumbar region. This indicates the development of a pathological process in the kidneys, which is a sign of the impossibility of removing accumulated urine from the organs. In some cases, due to the intensely growing symptoms, you even have to call an ambulance.
Diagnosis of pathology and therapeutic therapy for acute urinary retention
It is forbidden to solve problems with a heavy outflow of urine on your own. Independent attempts to empty the urea can adversely affect the state of health and aggravate the course of the disease.
For example, if you press hard on the peritoneum, the wall of the urinary organ may burst. The adoption of measures aimed at eliminating the overfilled bladder should be done by employees of medical institutions.
Only a doctor can make a diagnosis and provide primary care.
Transportation to a medical facility can be dangerous due to a very crowded urea (fraught with rupture), so first aid is provided to the patient at home
This happens by installing a catheter through which urine is excreted. To do this, a silicone tube with a very small diameter is installed (into the urination canal).
With the help of a catheter, the patient is released from muscle spasm, pushing the walls of the canal apart. This is done to easily remove accumulated urine. In some cases, home care is contraindicated for the patient, then the patient is taken to surgery, where surgery is performed through a tube that is inserted into the bladder through the peritoneum. Surgery is performed under general anesthesia, the procedure is called minimally invasive surgery.
The tube is left until the cause of the acute delay is found and eliminated. Sometimes the catheter is placed for a long period. To prevent the penetration of infection, periodic washing of the urea with antiseptics is carried out. Also, a specialist may prescribe broad-spectrum antibiotic therapy.
Acute urinary retention is the inability or insufficiency of self-emptying of a full bladder with painful urge to urinate.
ETIOLOGY AND PATHOGENESIS
Etiology.
Mechanical, neurogenic and functional causes, as well as the intake of certain drugs, can lead to acute urinary retention.
■ Mechanical:
□ adenoma and prostate cancer;
□ acute prostatitis;
□ sclerosis of the bladder neck;
□ foreign body of the bladder and urethra;
□ neoplasm of the lower urinary tract;
□ uterine prolapse.
■ Neurogenic:
□ spinal cord injury;
□ herniated disc;
□ multiple sclerosis, etc.
■ Functional (reflex dysfunction of the bladder):
□ pain;
□ excitement;
□ low ambient temperature, etc.
■ Taking certain medicines:
□ narcotic analgesics;
□ adrenomimetics;
□ benzodiazepines;
□ anticholinergic drugs;
□tricyclic antidepressants;
□ antihistamines, etc.
Pathogenesis.
Mechanical and dynamic factors are involved in the pathogenesis of acute urinary retention.
■ In older men, in response to a gradually increasing intravesical obstruction (mechanical factor), nervous regulation changes - the tone of smooth muscle cells m.detrusor vesicae increases and the detrusor hypertrophies. The histomorphological structure of the bladder wall is gradually changing: muscle elements are replaced by connective tissue, trabecularity develops. The volume of the bladder increases. The process passes into the stage of decompensation - hypotension of detrusor smooth muscle cells (dynamic factor) develops. In such a situation, any provoking factor (hypothermia, drinking alcohol, taking spicy food, prolonged sitting, constipation) causes venous congestion in the small pelvis, the veins of the bladder neck expand, prostate edema occurs, which, in turn, leads to deformation, compression prostatic urethra (mechanical component). Against the background of already existing pathological changes in the detrusor, acute urinary retention develops.
■ Often, acute urinary retention in the elderly occurs after the injection of antispasmodics due to a decrease in detrusor tone, more often with an existing urological disease (for example, prostate adenoma).
■ Reflex acute urinary retention is more often observed after surgery, especially in children, due to a violation of the nervous regulation of the detrusor and the external sphincter of the urethra, consisting of striated muscle fibers. In addition, reflex acute urinary retention can occur with injuries to the perineum, pelvis and lower extremities, with strong emotional upheavals, alcohol intoxication, fright and hysteria.
CLINICAL PICTURE
Acute urinary retention is characterized by:
■ painful urge to urinate;
■ anxiety of the patient;
■ severe pain in the suprapubic region (may be minor with slowly developing urinary retention);
■ a feeling of fullness in the lower abdomen.
COMPLICATIONS
In older men, acute urinary retention can become chronic and cause:
□ infection in the urinary tract (infectious agents can also be introduced during catheterization of the bladder);
□ acute and chronic cystitis and pyelonephritis;
□ acute prostatitis, epididymitis and orchitis;
□ stone formation in the bladder;
□ bilateral ureterohydronephrosis;
□ chronic renal failure.
DIFFERENTIAL DIAGNOSIS
Acute urinary retention is differentiated from anuria and paradoxical ischuria.
■ Anuria: the bladder is empty, there is no urge to urinate, palpation of the suprapubic region is painless.
■ Paradoxical ischuria: the bladder is full, the patient cannot urinate on his own, but urine is involuntarily excreted in drops. After emptying the bladder with a urethral catheter, urine leakage stops until the bladder overflows again.
ADVICE TO THE CALLER
■ Reassure the patient.
■ Minimize fluid intake.
■ Prior to the arrival of the ambulance, prepare the drugs that the patient is taking.
ACTIONS ON A CALL
Diagnostics
REQUIRED QUESTIONS
■ How long does the patient not urinate?
■ How did the patient urinate before acute urinary retention? What color was the urine?
■ What preceded acute urinary retention: hypothermia, alcohol intake, spicy food intake, prolonged forced position (sitting), constipation or diarrhea, infringement and inflammation of hemorrhoids?
■ Has the patient taken drugs that cause acute urinary retention [diazepam, amitriptyline, diphenhydramine (eg, diphenhydramine*), atropine, platyphylline, chloropyramine (eg, suprastin*), indomethacin, etc.]?
■ Have you had previous episodes of acute urinary retention? What did you buy?
■ Is the patient seen by a urologist?
■ Do you have BPH or other urinary tract diseases?
INSPECTION AND PHYSICAL EXAMINATION
■ Assessment of the general condition and vital functions: consciousness, respiration, blood circulation.
■ Study of the pulse, measurement of heart rate and blood pressure.
■ Visual inspection: identifying signs of trauma and inflammation of the external genitalia.
■ Identification of symptoms of acute urinary retention.
□ Symptom of the "ball": protrusion in the suprapubic region in patients with asthenic physique.
□ Palpation in the suprapubic region determines the formation of a rounded shape, elastic or densely elastic consistency.
Palpation is painful due to a strong urge to urinate.
□ Dull sound on percussion of the suprapubic region (more sensitive than palpation).
Treatment
■ Urgent emptying of the bladder by its catheterization with an elastic catheter.
□ Catheterization technique.
- Strict adherence to asepsis rules: use sterile rubber gloves, sterile tweezers, pre-treat the perineum and the area of the external opening of the urethra with a cotton ball moistened with a disinfectant solution (0.02% solution of chlorhexidine or nitrofural (for example, furacilin "), 2% solution of boric acid, etc.).
- Catheterization is performed delicately. It is necessary to generously lubricate the sterile catheter with sterile glycerol or paraffin oil. Insertion of the catheter should be gentle and non-violent. With a correctly performed catheterization, there should not be even the slightest sign of bleeding on the extracted catheter, as well as in the lumen of the urethra.
- In women, it is preferable to use a metal female catheter with a rubber tube attached to its end. Catheterization is carried out in the position of the patient with the hips apart and raised. The catheter is passed along a straight short female urethra to a depth of 5-8 cm until urine is obtained from its lumen.
Urinary retention(ischuria; acute complete urinary retention) - accumulation of urine in the bladder due to insufficiency or impossibility of independent urination.
ICD-10
R33 Urinary retention
N31 Neuromuscular dysfunction of the bladder, not elsewhere classified N31.1 Reflex bladder, not elsewhere classified
N31.2 Neurogenic bladder weakness, not elsewhere classified
N31.8 Other neuromuscular dysfunctions of bladder
N31.9 Neuromuscular dysfunction of bladder, unspecified
N32.0 Bladder neck obturation
N32.9 Bladder disorder, unspecified
N33 Disorders of the bladder in diseases classified elsewhere N39.9 Disorder of the urinary system, unspecified.
CAUSES
Since the urethra in women is much shorter than in men, urinary retention is extremely rare in them.
The most common cause is a mechanical obstruction to the passage of urine:
■ adenoma and prostate cancer;
■ acute prostatitis;
■ sclerosis of the bladder neck;
■ foreign body in the urethra;
■ urethral stone;
■ rupture of the urethra;
■ Neoplasms of the bladder and urethra.
Urinary retention may be associated with the pathology of the central nervous system or be reflex in nature:
■ tumors and injuries of the brain and spinal cord;
■ urinary retention in the postoperative period;
■ urinary retention during treatment for acute myocardial infarction;
■ neurogenic bladder dysfunction.
DIAGNOSTICS
HISTORY AND PHYSICAL EXAMINATION E
Allocate partial and complete urinary retention. With partial retention, urination is carried out, but urine flows out in a thin stream or drops, while the bladder is not completely emptied. Urinary incontinence with a full bladder is called paradoxical ischuria.
■ The patient is restless, as the clinic is determined by the sudden impossibility of emptying the bladder, accompanied by painful, sharp and fruitless urge to urinate, severe arching pains in the lower abdomen. Pain can spread throughout the abdomen.
■ Since there is a reflex paresis of the intestine, bloating appears, symptoms of irritation of the peritoneum may be noted.
■ When viewed in the suprapubic region, a bulge is determined, which is especially visible to the eye in thin subjects. With percussion - dullness (a distinguishing feature from bloating). Palpation is usually easily determined by an enlarged bladder. Palpation is painful and increases the urge to urinate.
DIFFERENTIAL DIAGNOSIS
■ First of all, the situation has to be differentiated from anuria. History matters. With anuria, there are:
✧ water and electrolyte disturbances;
✧ the smell of urine in the exhaled air;
✧ lack of urge to urinate;
✧ The bladder is empty.
■ Intestinal obstruction is manifested by repeated vomiting, bloating, increasing dehydration. At a late stage, intestinal paresis and a picture of an acute abdomen develop.
■ Acute surgical pathology in the abdominal cavity is characterized by abdominal pain of a different nature. No urge to urinate. An objective examination showed severe pain in some area of the abdomen or throughout the abdomen, symptoms of peritoneal irritation. The enlarged bladder in the suprapubic region is not palpated.
■ The result of bladder catheterization has a differential diagnostic value: the evacuation of a large amount of urine and the rapid improvement in the patient's condition indicates precisely acute urinary retention.
TREATMENT
THERAPEUTIC MEASURES
Acute urinary retention is classified as a urological emergency requiring emergency intervention.
Shown emergency emptying of the bladder. Intervention is carried out already at the prehospital stage. To do this, catheterization is carried out with an elastic catheter (a metal catheter cannot be used) or a suprapubic puncture of the bladder.
■ When catheterizing the bladder, asepsis must be observed. It is performed using sterile equipment. Catheterization in men requires a certain skill. It is carried out as follows:
The patient is in the supine position.
✧ The penis is grasped with the fingers of one hand using a sterile bandage; holding it in a slightly stretched upward state, expose the head, wipe it with a disinfectant solution on a sterile swab.
✧ It is advisable to introduce 10 ml of 1% lidocaine gel into the urethra; in the absence of a gel, sterile vaseline oil is used, which is applied to the catheter.
✧ The catheter is inserted with smooth jerks until it penetrates into the bladder, as evidenced by the appearance of urine at the outlet (in case of an obstacle at the last stage before the catheter penetrates into the bladder, you need to slightly press on the catheter, wait 1-2 minutes - the catheter itself is easy will go further).
✧ Urine is collected for possible research in a sterile container.
■ Because women's urethra are shorter than men's, bladder catheterization is easier. Manipulation is performed in compliance with the same rules of asepsis. The mouth of the urethra is found by spreading the small lips as much as possible.
■ Contraindications for catheterization are inflammatory processes in the area of the mouth of the urethra, urethritis, acute prostatitis, trauma of the urethra (history of trauma, bleeding from the urethra).
If catheterization fails, a suprapubic puncture of the bladder can be performed, but at the prehospital stage, an attempt to puncture the bladder should be made only as a last resort, when the delivery of the patient to the hospital will take a long time. Contraindications are acute cystitis, paracystitis, suspicion of a tumor of the bladder or a decrease in its capacity (tuberculosis, interstitial cystitis, etc.).
Suprapubic bladder puncture technique:
■ the patient is in the supine position;
■ make sure that the formation, palpated above the pubis, is due precisely to the overflow of the bladder;
■ observe asepsis as much as possible (as during the operation: sterile mask, gloves, gown, cap);
■ infiltrate the skin with 1% lidocaine solution 2–3 cm above the upper edge of the pubic symphysis along the midline, having previously treated it with an antiseptic (the hair directly in the place where the puncture will be performed can be cut with scissors);
■ perform a puncture with a thick long needle (with a clearance of 1 mm; length 15–20 cm) with a syringe connected to it;
■ insert the needle strictly vertically, constantly pulling the plunger of the syringe. During the puncture, the needle encounters two dense layers - the skin and the aponeurosis of the external oblique muscles, after which it freely penetrates through the muscle layers of the anterior abdominal wall and the wall of the bladder. Penetration of the needle into the bladder leads to the appearance of urine in the syringe. To drain urine, a sterile tube is put on the needle;
■ remove the needle at the end of the manipulation.
After the intervention, the patient is usually hospitalized in the urological department for the purpose of additional examination and further treatment.
FORECAST
The prognosis for urinary retention depends solely on the disease that caused it. On the one hand, in some patients, a single urinary retention associated with stress or other psychological factors may never happen again. On the other hand, in the presence of an organic pathology of the urogenital organs or the central nervous system (in the case of functional urinary retention), the condition recurs.
Acute urinary retention occurs as a result of compression of the urinary tract (adenoma or prostate cancer, cicatricial stricture of the urethra, prostatitis) with a decrease in the contractility of the muscular wall of the bladder. With prostate adenoma I - II degree, acute urinary retention is facilitated by pelvic organ goperemia (alcohol consumption, hypothermia, overwork, prolonged urinary retention, prolonged sitting or lying down), less often - the appointment of diuretics. Any of these predisposing factors leads to overdistension of the bladder and loss of detrusor function.
Code according to the international classification of diseases ICD-10:
Acute prostatitis often occurs at a young age. Untreated or poorly treated prostatitis is often accompanied by dysuric symptoms. In the diagnosis, the general phenomena of inflammation are important: temperature, chills, pain in the perineum. With a digital examination of the prostate gland, its abscess formation is often determined. Acute urinary retention is often the first symptom of cicatricial stricture of the urethra. A carefully collected history helps in the diagnosis. Neurogenic dysfunction of the bladder can also be accompanied by an increase in residual urine up to acute retention. Neurogenic dysfunction is the result of spinal cord injury, pelvic surgery, general anesthesia, spinal anesthesia, medications that affect the innervation of the bladder, proximal urethra, or external sphincter. In women, acute urinary retention usually develops as a result of neurogenic and psychogenic factors or compression of the urethra by a cancerous tumor, cicatricial stricture, etc.Symptoms, course. Pain in the lower abdomen, urge to urinate. On palpation above the pubis, a pear-shaped, slightly painful formation of a densely elastic consistency is determined.
Diagnostics
Diagnosis specified during catheterization of the bladder.
Treatment
Treatment. Single or permanent catheterization of the bladder until the restoration of its function. After the elimination of acute urinary retention, it is necessary to examine the patient and treat the underlying disease that led to its development.
Complications catheterization: damage to the wall of the urethra, acute orchiepididymitis, urinary tract infection.
Forecast depends on the underlying disease.
Diagnosis code according to ICD-10. R33