Cerebrovascular accident
Painful perianal conditions
BPH, a urethral stone or a stricture
Chronic retention
Painless non tender palpable bladder
A suprapubic lump which is stony dull to percussion
Bladder almost reaches the umbilicus
Recent onset nocturnal enuresis
Chronic retention is more dangerous than acute retention. It results in chronic renal failure, due to vesicoureteric retlux,
hydronephrosis and obstructive uropathy.
Other causes of incontinence
Cauda equina syndrome.
Spinal cord injury.
Chronic subdural haematoma.
Frontal lobe tumour
Damage to the sphincter urethrae.
Urine infections
Features:
Fever with chills and rigors.
Dysuria.
Frequency
Pyuria.
Haematuria.
Lower abdominal pain.
Loin pain
Vomiting
Stone formation
Especially the bladder stones in the postprostatic pouch because
of urinary stasis and infection.
Obstructive uropathy
Chronic retention resulting in vesicoureteric reflux and either
unilateral or bilateral hydroureter or hydronephrosis.
Chronic renal failure
Hypertension
Polyuria
Anaemia
Undue exertional dyspnoea
Dizziness
Exercise intolerance
LUTS – Lower Urinary Tract Symptoms
Model History:
Mr. Piyasiri, a 76 year old farmer from Rathgama. He has acute retention of urine for 12 hrs.
He gives a history of hesitancy, terminal dribbling. poor stream and intermittent stream as obstructive features, and nocturia, frequency, urgency as irritative features of 6 months duration.
He does not have precipitancy. He had a similar attack of acute urinary retention one month ago. It was managed
conservatively. He does not have nocturnmal incontinence. He
also gives a history of dysuria, lower abdominal pain and low grade fever suggestive of a UTI. There is no history of bladder carcinoma or irradiation.
He had no history of dragging
sensation in loin, intractable backache or a limp suggestive of
bone metastases (carcinoma prostate). He is not complaining of
any polydipsia, dyspnoea or dizziness indicative of anaemia.
He has not undergone recent urethral instrumentation. He does
not give a history of purulent urethral discharge. He does not complain of any impotence or perianal anaesthesia. He is not
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