Persons with urine retention
are often not aware that their
bladder cannot fully empty,
which poses a threat for their
health and their life.
Urinary retention is the inability to completely empty the bladder. It can be acute or chronic. Acute retention is a sudden and often painful inability to excrete urine. Chronic retention, however, is usually painless, associated with the dilation of the upper urinary tract.
Acute urinary retention is a potentially life-threatening medical condition which requires immediate emergency treatment.
Chronic urinary retention is insidious and silent. Patients with chronic retention may urinate but cannot empty the bladder completely. They are often not even aware that urine is still in the bladder after micturition. It is often discovered when other problems in terms of urinary incontinence occur, such as urinary tract infections, kidney failure, bladder damage, and so on.
Chronic urinary retention can lead to complications. It is important to see your doctor promptly if you have one or more of the following symptoms:
Your doctor can often diagnose urinary retention just by obtaining a detailed history of your symptoms and performing a physical exam that includes your genitals and rectum.
At the doctor’s, your full history should be obtained including:
Optimally, a urinary diary with voiding patterns, fluid intake, and voiding issues can help with patient evaluation and the formulation of treatment recommendations.
A physical examination focusing on pelvic anatomy and the neurologic system is essential. Neurological examination will determine if there are neurologic conditions present that may contribute to the voiding dysfunction. Mechanical issues such as prostate enlargement or bladder prolapse that may impact voiding function can be found on the urologic exam.
When your doctor needs more information, they may use one of the following tests or procedures:
Laboratory evaluation of patients with a neurogenic bladder should include urinalysis, urine culture and sensitivity, and serum creatinine.
Ultrasound is a non-invasive method of determining post-void residual urine volumes, especially if precise measurement is not required. The bladder can be scanned after a void to estimate the residual volume. Many experts believe that a PVR of <100–200 ml indicates acceptable emptying to prevent infection and normal detrusor function. It can also be performed with transurethral catheterization immediately after voiding. It should always be performed after discontinuing Foley catheterization or before instituting intermittent catheterization as part of the bladder retraining program.
Uroflowmetry rate evaluation is a non-invasive way to quantify urinary flow. Urine flow is dependent on the force of detrusor contraction as well as the urethral resistance.
Urine flow rate patterns are not diagnostic, but high flow rates are often seen with neurogenic detrusor overactivity, and poor flow rates may reflect weak detrusor pressure and/or urinary outlet obstruction.
Urodynamic evaluation should be completed to assess urinary function. Urodynamic studies are the most definitive and objective means to determine abnormalities in the bladder and urethra in the filling/storage phase as well as in the voiding phase in neurogenic bladder dysfunction.
For the purpose of the examination, one catheter is placed in the rectum and the other one through the urethra into the bladder. Electrodes are applied to the area of the posterior opening, monitoring the activity of the pelvic floor muscles.
During the examination, the bladder is filled with saline and your feelings about the fullness of the bladder and the desire to urinate are checked. When the urge to urinate is so strong that you can no longer hold urine, you will urinate into the prepared container. The examination allows an assessment of the functioning of the bladder, whether the bladder is stable or is shrinking uncontrollably or there is uncontrolled urine leakage, and whether urine leakage is normal.
Bladder pressures are monitored during filling and emptying by using a transurethral catheter connected to a pressure transducer, and intra-abdominal pressure is often measured as well.
INSTRUCTIONS TO PATIENTS BEFORE EXAMINATION
Initial urodynamic studies in patients with a spinal cord injury should be performed after the spinal shock phase, and urine retention should be managed by clean intermittent catheterization or, exceptionally, with an indwelling catheter. After the spinal shock, involuntary and uncoordinated bladder contraction might occur and result in reflex bladder function.
Studies recommend a urinalysis every 6 months, a urine culture whenever the patient is symptomatic, an ultrasound of the upper tract every 6 months, and a urodynamic evaluation every 1–2 years. Patients with a high detrusor pressure or a decreased compliance require a urodynamic evaluation within 12 months of the treatment.
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