What Is Urinary Diversion?

Urinary retention means that the bladder is full of urine and cannot be excreted normally. According to its history and characteristics, acute urinary retention and chronic urinary retention are divided into two categories. Acute urinary retention is sudden onset, and the bladder is suddenly full of urine and cannot be discharged, and the patient is very distressed. Emergency treatment is often needed; chronic urinary retention has a slow onset and a long course of disease, and the lower abdomen can touch the bladder full of urine, but the patient cannot empty the bladder, but it is not serious due to the long-term existence of the disease and the pain of adaptation.

Basic Information

English name: urinary retention
Visiting department: Urology
Multiple groups: Older men
Common locations: bladder

Common causes: Mechanical obstruction of urethral or bladder outlet caused by various organic lesions
Common symptoms: The bladder is full of urine and cannot be discharged, soreness, poor urination, frequent urination, endless urination, urinary incontinence
Contagious: no

Causes of urinary retention

Common causes are mechanical obstruction of the urethra or bladder outlet due to various organic lesions, such as inflammation, foreign bodies, stones, tumors, injuries, stenosis, and congenital urethral malformations due to urethral lesions; bladder neck obstructive lesions include bladder neck Contractures, fibrosis, tumors, acute prostatitis or abscesses, benign prostatic hyperplasia, prostate tumors, etc. In addition, pelvic tumors, pregnant uterus, etc. can also cause urinary retention. There are also dynamic obstructions due to dysuria dysfunction. Common causes are central and peripheral nervous system diseases, such as spinal cord or horsetail injuries, tumors, pelvic surgery injuries that control the nerves that control the bladder, and diabetes, which cause neurological bladder dysfunction. There are also drugs that relax smooth muscle, such as atropine, probencin, scopolamine, and occasionally cause urinary retention.

Clinical manifestations of urinary retention

Sudden onset of acute urinary retention. The bladder is full of urine and cannot be excreted. The pain and pain are unbearable and uneasy. Sometimes urine overflows from the urethra, but it does not relieve lower abdominal pain.

Chronic urinary retention is manifested by poor urination and frequent urination, often with insufficiency, and sometimes urinary incontinence. Although a few patients have no obvious symptoms of chronic urinary retention obstruction, they often have obvious upper urinary tract dilatation, hydronephrosis, and even symptoms of uremia, such as weakness, anemia, respiratory odor, lack of appetite, nausea and vomiting, and anemia. , Elevated serum creatinine and urea nitrogen.

It must be pointed out that the absence of urination by a patient is not the same as retention of urine.

Urinary retention test

For patients with unclear diagnosis, B-ultrasound can be performed.

Differential diagnosis of urinary retention

Urinary retention should be distinguished from anuria. Some people experience symptoms of anuria, not retention of urine, often because of renal failure and the inability of the kidneys to produce enough urine. For patients with unclear diagnosis, B-ultrasound can be performed. If there is no urine in the bladder, it may be caused by impaired kidney function. Active treatment should be performed to restore kidney function as soon as possible.

Urinary retention treatment

Acute urinary retention

The principle of treatment is to eliminate the cause and resume urination. If the cause is unknown or the obstruction is difficult to relieve for a while, urinary catheterization or suprapubic cystostomy drainage of the bladder urine should be performed to relieve the pain, and then further examination to determine the cause. If the pubic bladder area hot compress or acupuncture still can not urinate, urethral catheterization is possible, and those who cannot retain urine for a short period of time should be kept in urinary catheter for continuous catheterization, and removed as appropriate. Patients with acute urinary retention can perform a suprapubic bladder fistula when the catheter cannot be inserted. If there is no bladder puncture needle, a suprapubic cystostomy can be performed. If the cause of the obstruction cannot be resolved, the urine can be permanently drained and the fistula can be replaced regularly.

When placing a urinary catheter or bladder puncture to drain urine for acute urinary retention, the urine should be released slowly and intermittently, 500-800ml each time, to avoid rapid emptying of the bladder, and a sudden decrease in bladder pressure causes massive bleeding in the bladder.

2. Chronic urinary retention

If it is caused by a mechanical obstructive disease and there is hydronephrosis and impaired renal function in the upper urinary tract, the urine of the bladder should be drained first. If it is caused by dynamic obstruction, most patients need to keep the urinary catheter and replace it regularly; those with severe upper urinary effusion can do urinary diversion such as suprapubic cystostomy or nephrostomy.

According to the condition, treat the primary disease and remove the obstruction. For patients with benign prostatic hyperplasia, prostatectomy is feasible; for patients who cannot tolerate prostatectomy, suprapubic cystostomy is feasible. Patients with bladder neck obstruction should undergo transurethral resection of the bladder neck or bladder neck plasty. For those with urethral stricture, urethral dilatation or cold knife incision under transurethral peeping is feasible. Bladder stones should be removed. Bladder tumors should be treated accordingly. For neurogenic bladder and bladder detrusor contraction weakness can be treated with drugs first, if not effective, a cystostomy should be performed.