eMentorSurgery

Dear students, This is only for your revision and NOT A FULL TEXT.

Retention of urine

Causes:

•        1. Phimosis

•        2. Meatal stenosis

•        3. sricture urethra

•        4. stone in the urethra

•        5. posterior urethral valve

•        6. Urethritis

•        7. Benign enlargement ofprostate

•         8. carcinoma of prostate

•         9. prostatitis

•        10. Bladder neck hypertrophy

•        11. urethral injury

•        12. neurogenic bladder

•        13. post operative period-hemorrhoids, pelvic surgery

Clinical features

•        1. inability to pass urine

•        2. difficulty in passing urine

•        3. pain swelling in the supra pubic area

•        4. fullness in the suprapubic region

•        5. finding for specific disease

Types

•          1. acute

•          2. chronic

•          3. retention with overflow

Investigations

•        1. urine examination- infectionwill show pus cells, albumin, RBC

•        2. Blood urea, creatinine

•        3. Ultra sonogram

•        4. voiding cystourethrogram

•        5. ascending urethrogram

•        6. IVU

•        7. cystoscopy

Treatment

•        1. urinary catheterisation

•        2. if it fails suprapubic cystostomy

Bladder outlet obstruction (BOO)

The micturitionreflex should result in a few ml of urine left in the bladder.

•        There are 3 principal problems whichcan arise with the process of micturition.

•        The urethra becomes obstructed usuallydue to hyperplasia of the prostate

•        The detrusor-sphincter co-ordinationis lost. This is called detrusor-sphincter dyssynergia.

•        Underactive detrusor muscle.

•        The urethra passes through the prostateand thus enlargement of the prostate can obstruct the flow.

•        Although the detrusor may contract andthe sphincter relax, the obstructive resistance increase due to prostate may betoo great for adequate emptying of the bladder.

•        All of the above 3abnormalities can be investigated by the pressure-flow study.

•        Detrusor pressure and flow rateare measured simultaneously - often with a suprapubic catheter so that there isno obstruction to the flow as there would be with urethral catheterisation.

•         The data is presented as pressure flow studyis  ploted  pressure against flow.

•        The ideal investigation for BPH is thepressure flow study , where simultaneous flow and pressure measurements can beused to accurately diagnose bladder output obstruction.

•        However the pressure flow is invasive,with either a urethral or suprapubic catheter being inserted.

•        The free flow investigation is thereforethe method of choice for most routine patients.

•        It is totally non-invasive.

•        normal flow rates. The shape ofthe curve is unimodal i.e. monotonic increase, stable period,monotonicdecrease.

•        Qmax is 19 in the first and 23in the second.

•        Qmax depend on volume

Management depends on the disease

Foley Urethral Catheterization

Indications

Assess indications.  Note that catheter insertion carries a risk of infection.  A specific surgical consent is not generally obtained.  Explain urethral catheterization (may be intermittent or indwelling).

Indications

    Diagnostic

To collect uncontaminated urine specimen

    Study anatomy of the urinary tract

    Urine output monitoring

    Therapeutic

    Acute urinary retention

    Chronic obstruction causing hydronephrosis

    Intermittent bladder decompression for neurogenic bladder

    Chronically bed-ridden patients for hygiene

Contraindications

Urethral injury                                            

Trauma patients with blood at meatus or abnormal prostate location on rectal exam.

 Equipment

1. Catheter tray.

2. Foley catheter:18 F  adults

    3. 18 F  Coudé if obstruction at prostrate

    4. 5 – 12 F children

    5. 5 F feeding tube with tape – infants < 6 months

6. Drainage bag.

7. Transurethral topical Lidocaine jelly   [OPTIONAL]

Procedure

1. Consider prophylactic antibiotics: valvular heart disease or acute prostatitis.

2. Consider intraurethral anesthetic.

    3. Position: supine, frogleg or knees flexed.

    4. Locate meatus.

    5. Apply antiseptic.

    6. Gently insert lubricated tube until urine is obtained.

    7. Inflate retention balloon slowly with 5cc-10cc  (mentioned in catheter) saline.

    8. Connect to drainage system.

    9. Secure tube with tape.   

Removal

Deflate retention balloon by aspirating contents with 10cc syringe from side port.