Acute urinary retention in benign prostatic hyperplasia. Chronic and acute urinary retention in men: causes and treatment of accumulation of urine without the ability to withdraw from the bladder

- This is a pathological condition characterized by a violation or impossibility of normal emptying of the bladder. Symptoms are pain in the pubic region and lower abdomen, very strong persistent urge to urinate and the resulting psychomotor agitation of the patient, a noticeable decrease in urine output or its absence. Diagnosis is based on a patient interview, the results of a physical examination, and ultrasound methods are used to determine the causes of the condition. Treatment - catheterization or cystostomy to ensure the outflow of urine, elimination of etiological factors of ischuria.

Urinary retention or ischuria is a fairly common condition that accompanies a significant number of various urological pathologies. Young men and women suffer from it in about the same way, as the age increases, male patients begin to prevail. This is due to the influence of pathologies of the prostate gland, which are usually determined in the elderly and are often manifested by urination disorders. Approximately 85% of all cases of ischuria in men over 55 are due to problems with the prostate. Urinary retention rarely occurs in isolation, more often it is part of a symptom complex caused by urological, neurological or endocrine pathologies.

Causes

Urinary retention is not an independent disease, it always acts as a consequence of various pathologies of the excretory system. It should be distinguished from another condition, also characterized by the absence of urine output - anuria. The latter occurs due to damage to the kidneys, leading to the complete absence of urine formation. With urinary retention, fluid forms and accumulates inside the bladder cavity. This difference causes a different clinical picture, similar only in the volume of diuresis. The main reasons preventing the normal discharge of urine are:

• Mechanical blockade of the urethra. The most common and diverse group of causes that cause ischuria. These include strictures of the urethra, its obturation with a stone, tumor, blood clots, severe cases of phimosis. Blockade of the urethra can also be caused by neoplastic and edematous processes in nearby structures - mainly the prostate gland (adenoma, cancer, acute prostatitis).
• dysfunctional disorders. Urination is an active process, for the normal provision of which an optimal contractility of the bladder is necessary. Under certain conditions (dystrophic changes in the muscle layer of the organ, impaired innervation in neurological pathologies), the contraction process is disrupted, which leads to fluid retention.
• Stress and psychosomatic factors. Some forms of emotional stress can lead to ischuria due to inhibition of the reflexes that provide the process of urination. Especially often this phenomenon is observed in people with mental disorders or after severe shocks.
• Medicinal ischuria. A special type of pathological condition caused by the action of certain drugs (narcotic, sleeping pills, cholinergic blockers). The mechanism for the development of urinary retention is complex, due to the complex effect on the central and peripheral nervous system and bladder contractility.

Pathogenesis

Pathogenetic processes in different types of urinary retention are different. The most common and studied is mechanical ischuria, due to the presence of an obstruction in the lower urinary tract. These can be cicatricial narrowing (strictures) of the urethra, severe phimosis, urolithiasis with the release of calculus, prostate pathology. After some manipulations on the bladder (surgery, taking a biopsy of the mucosa) or bleeding in the urine, blood clots form, which can also obstruct the lumen of the urethra and prevent the outflow of urine. Strictures, phimosis, pathologies of the prostate usually lead to slowly progressive ischuria, while when a calculus or blood clot is released, the delay occurs abruptly, sometimes at the time of urination.

Dysfunctional disorders of the urinary tract are characterized by a more complex pathogenesis of urinary excretion disorders. Obstacles to the outflow of fluid are not observed, however, due to a violation of contractility, the emptying of the bladder occurs weakly and incompletely. Violations of innervation can also affect the sphincters of the urethra, as a result of which the process of their disclosure, which is necessary for urination, is disrupted. Stress, pharmacological variants of this pathology are similar in their pathogenesis - they arise reflexively due to disorders in the central nervous system. There is a suppression of natural reflexes, one of the manifestations of which is ischuria.

Classification

There are several clinical variants of urinary retention, differing in the suddenness of development and duration of the course. Each of these varieties, in turn, depending on the nature of the delay, is divided into complete and incomplete. With complete ischuria, emptying the bladder in a natural way is impossible, urgent medical intervention is required. With incomplete variants, urine output occurs, but very weakly, some volume of liquid remains inside the bladder. Each type of pathology also differs in etiological factors; in total, three variants of this condition are distinguished in clinical urology:

• Acute delay. It is characterized by a sudden abrupt onset, most often due to mechanical causes - obstruction of the urethra by a stone or a blood clot, sometimes a neurogenic variant of the condition is possible. With incomplete forms, there is a weak excretion of urine with pressure on the lower abdomen or a strong tension in the abdominal press.
• chronic delay. It usually develops gradually against the background of strictures of the urethra, diseases of the prostate, dysfunctions, tumors of the bladder, urethra. The rare complete form requires long-term (sometimes for several years) catheterization. In incomplete chronic forms, the amount of residual urine can reach large volumes - up to several hundred milliliters or more.
• Paradoxical ischuria. A rare variant of the disorder, in which, against the background of filling the bladder and the impossibility of voluntary urination, there is a constant uncontrolled release of a small amount of fluid. It can be mechanical, neurogenic or medicinal etiology.

There is a less common and more complex classification of urinary retention, based on their relationship with other diseases of the excretory, nervous, endocrine or reproductive systems. But, given the fact that ischuria is almost always a symptom of some disorder in the body, the relevance and validity of such a system remains in question. In some cases, different forms of the condition can turn into one another, for example, acute delay - chronic, complete - incomplete.

Symptoms of urinary retention

Any type of ischuria is usually preceded by manifestations of the underlying disease - for example, renal colic, due to the release of a stone, pain in the perineum associated with prostatitis, urination disorders due to strictures, etc. interrupted, further outflow of urine becomes impossible. This is how ischuria can manifest itself with urolithiasis or obstruction of the urethra with a blood clot - a foreign body is displaced along with the fluid flow and blocks the lumen of the canal. In the future, there is a feeling of heaviness in the lower abdomen, a strong urge to urinate, pain in the groin.

In acute incomplete ischuria, a weak thin stream may appear with strong abdominal tension or pressure on the suprapubic area. Urination brings almost no relief, since a significant amount of fluid remains in the bladder. After catheterization and treatment of the causes of ischuria, the symptoms completely disappear. Chronic urinary retention is rarely complete and usually develops gradually. Initially, patients may experience a decrease in urine volume, a feeling of incomplete emptying of the bladder, and frequent urination associated with this circumstance.

In the absence of progression of the causes of chronic incomplete ischuria, the symptoms may subside, however, studies reveal the retention of residual urine after each emptying, against this background, inflammation of the bladder mucosa (cystitis) often occurs, which can be complicated by pyelonephritis. The full variety of chronic urinary retention differs from acute only in the period of catheterization of the patient. In almost any form of delay, its first difference from anuria is the excited psycho-emotional state of the patient, due to the impossibility of urination.

Complications

Urination retention with a long absence of qualified assistance leads to an increase in fluid pressure in the overlying sections of the urinary system. In acute forms, this can cause the phenomena of hydronephrosis and acute renal failure, in chronic forms - chronic renal failure. Stagnation of residual urine facilitates tissue infection, therefore, the risk of cystitis and pyelonephritis increases.

In addition, with significant volumes of retained urine, conditions are created in it for the crystallization of salts and the formation of bladder stones. As a result of this process, a chronic incomplete delay is transformed into an acute and complete one. A relatively rare complication is the formation of a bladder diverticulum - a protrusion of its mucosa through defects in other layers, due to high pressure in the organ cavity.

Diagnostics

Usually, the diagnosis of "ischuria" does not cause any particular difficulties for a urologist, a simple questioning of the patient, examination of the suprapubic and inguinal regions is sufficient. Additional research methods (ultrasound diagnostics, cystoscopy, contrast radiography) are required to determine the severity and causes of the pathological condition, the choice of effective etiotropic therapy. In patients with chronic variants of ischuria, auxiliary diagnostics is used as a monitoring of the progression of the pathology and timely detection of urinary retention complications. The vast majority of patients use the following diagnostic methods:

• Questioning and inspection. Almost always they allow to determine the presence of acute urinary retention - patients are restless, complain of a strong desire to urinate and pain in the lower abdomen. On palpation of the suprapubic region, a dense filled bladder is determined; in lean patients, bulging can be noticeable from the side. Chronic incomplete varieties of the disorder are often asymptomatic, there are no complaints.
• Ultrasound diagnostics. In acute conditions, ultrasound of the bladder, prostate, urethra allows you to establish the cause of the pathology. A stone is defined as a hyperechoic mass in the lumen of the urethra or in the region of the neck of the bladder, but blood clots are not detected by most ultrasound machines. Ultrasound examination of the urethra, prostate can diagnose strictures, adenomas, tumors and inflammatory edema.
• neurological research. A consultation with a nephrologist may be required if neurogenic or psychosomatic causes of ischuria are suspected.
• Endoscopic and radiopaque techniques. Cystoscopy helps to determine the cause of the delay - to identify the stone, blood clots and their source, strictures. Retrograde cystourethrography is the gold standard in determining the amount of residual fluid, therefore it is used to diagnose incomplete forms of pathology.

Differential diagnosis is made with anuria - a condition in which the excretion of urine by the kidneys is impaired. With anuria, patients have no or sharply weakened urge to urinate, manifestations of acute or chronic renal failure are observed. Instrumental diagnostics confirms the absence or an extremely small amount of urine in the bladder cavity.

Treatment of urinary retention

There are two main stages of therapeutic measures for ischuria: emergency provision of normal urine outflow and elimination of the causes that caused the pathological condition. The most common method of restoring urodynamics is bladder catheterization - the installation of a urethral catheter, through which fluid is drained.

Under some conditions, catheterization is not possible - for example, with severe phimosis and strictures, tumor lesions of the urethra and prostate gland, "impacted" calculus. In such cases, they resort to cystostomy - the formation of a surgical access to the bladder and the installation of a tube through its wall, which is brought out to the front surface of the abdomen. If a neurogenic and stressful nature of ischuria is suspected, conservative methods of restoring the outflow of urinary fluid can be used - turning on the sound of flowing water, washing the genitals, injections of M-cholinomimetics.

The treatment of the causes of urinary retention depends on their nature: for urolithiasis, crushing and extraction of the calculus are used, for strictures, tumors and lesions of the prostate - surgical correction. Dysfunctional disorders (for example, hyporeflex type of neurogenic bladder) require complex complex therapy involving urologists, neuropathologists and other specialists. If the cause of ischuria is taking medications, it is recommended to cancel them or correct the drug therapy regimen. Urinary retention due to stress can be eliminated by taking sedatives.

Forecast and prevention

In most cases, the prognosis of urinary retention is favorable. In the absence of medical care, acute variants of the pathology can provoke bilateral hydronephrosis and acute renal failure. With the timely elimination of the causes that caused this condition, relapses of ischuria are extremely rare.

In chronic variants, the risk of infectious and inflammatory diseases of the urinary tract and the appearance of stones in the bladder increases, so patients should be regularly observed by a urologist. Prevention of urinary retention is the timely detection and proper treatment of pathologies that cause this condition - urolithiasis, strictures, prostate diseases and a number of others.

Acute urinary retention requires urgent medical attention: the accumulation of urine without the possibility of withdrawal from the bladder can lead to serious consequences. It is important to know the main causes of a dangerous condition and the rules for first aid.

Reasons for the development of pathology

The main factor that provokes problems with urination is a benign and malignant tumor of the prostate. The overgrown tissues of the gland lead to compression and impaired patency of the urethra.

With swelling of the prostate tissues, pressure on the walls of the urethra interferes with the free outflow of urine, fluid stagnation develops, and the inflammatory process intensifies. With prostate adenoma, doctors detect an acute form of urinary retention in 1-7% of patients.

Other causes of ischuria in men:

• blockage of the urethra with a stone or blood clot;
• weak urine flow - indicators below 12 ml / s;
• narrowing of the urethra with an active inflammatory process;
• injury to the prostate;
• inflammation and development of prostate abscess;
• prostate cancer;
• consequences of operations on the bladder, bean-shaped organs, prostate gland;
• prolonged bed rest after surgical treatment;
• pathologies of the nervous system, provoking a violation of the tone of the bladder, sphincters and urethra.

Problems with the excretion of fluid in most cases develop in old age, in patients whose prostate volume exceeds 40 ml. With sedentary work, persistent constipation, addiction to alcohol, ischuria in men is diagnosed more often. An important point for determining the risk of prostate cancer is a PSA level above 2.5 ng / ml. Ishuria ICD code - 10 - R33.

First signs and symptoms

Acute urinary retention (ischuria) is dangerous for the body. Men should know the first symptoms of a dangerous condition in order to see a doctor in time.

It is important to pay attention to several factors:

• a gradual decrease in the amount of urine excreted in one urination;
• pain and, difficulty emptying the bladder;
• against the background of the inflammatory process, the temperature rises, weakness appears, the head hurts, nausea and vomiting are possible;
• pain in the inguinal zone with the pressure of a bubble filled with liquid;
• discomfort and tension in the pubic area with an overflowing bladder;
• decreased sexual function.

Types and forms of the disease

Negative signs depend on the form of ischuria:

• Acute. Urinary retention develops suddenly, painful and appear, but it is almost impossible to remove urine. The bubble is full, exceeding the critical size can lead to rupture of the organ. As a result, liquid with dissolved toxins penetrates into the abdominal cavity, peritonitis develops. The accumulation of harmful substances quickly provokes poisoning of the body, the patient's condition worsens. Without immediate assistance, death is possible.
• Chronic. With an incomplete form of ischuria, the patient empties the bladder, but not completely, stagnant remnants increase inflammation, as the pathology progresses, the symptoms appear brighter. With the development of the full form of the disease, bladder catheterization is required to remove urine: a man is not able to independently control the physiological process.
• Paradoxical ischuria. This form of pathology develops with a strongly stretched bladder. The process of urination is disturbed, it is difficult to urinate, but urine is involuntarily released dropwise from the urethra.

Diagnostics

In the chronic form of pathology, many men do not seek medical help until a critical moment arrives with the development of complete ischuria. It is not difficult to recognize the acute form of urinary retention: the patient cannot urinate without the introduction of a catheter, the general state of health deteriorates sharply, symptoms of intoxication appear.

Diagnostics is necessary to establish the factor that provoked the violation of the outflow of urine. Often, men do not suspect that the cause lies in the tumor, calculi, or compression of the urethra.

The urologist prescribes:

• laboratory tests of urine and blood, necessarily, bakposev if an infectious pathology is suspected;
• ultrasound examination of the bladder cavity, prostate tissues, kidneys.

On a note! On palpation of the pubic area, the doctor reveals an increased size of the bubble, pressure on this area provokes pain due to excess accumulated fluid. An important indicator is the volume of fluid received and excreted (data per day), an ultrasound of the bladder after urination. If the amount of residual urine exceeds 200 ml, then the urologist diagnoses urinary retention.

Valid Therapy Options

In the acute form of ischuria, it is important to provide first aid - to conduct. The timely call of an ambulance prevents serious complications, reduces the risk of intoxication and peritonitis in case of organ rupture.

After emptying the bladder, antibacterial compounds are prescribed, drugs that reduce signs of intoxication. It is important to eliminate the inflammatory process, normalize the functioning of the bean-shaped organs and the bladder. In critical situations, hemostatic and anti-shock procedures are required.

Treatment is carried out taking into account the factor that provoked ischuria:

• crush and withdraw;
• remove the tumor in the tissues of the prostate;
• carry out stenting of the urethra to normalize the outflow of urine;
• remove blood clots or stones that clog the urethra;
• in critical situations, an emergency operation is performed for an acute form of ischuria, if a blockage of the urethra is detected or the tissues of the inflamed prostate have grown so much that surgical treatment is indispensable;
• prescribe drugs that reduce muscle hypertonicity with neurogenic dysfunction;

Go to the address and read about the features of determining the daily diuresis in men and women.

Possible Complications

If left untreated, ischuria can lead to serious consequences:

• pathogenic bacteria actively multiply in stagnant urine, inflammation appears, toxins from the urinary tract penetrate into other parts of the body, develop,. Blood poisoning is especially dangerous for the patient () - a condition that threatens health and life;
• with a noticeable overflow of urine, complete ischuria, the bladder stretches, there is a possibility of rupture of an important organ. Urine that has poured into the tissue contains harmful microorganisms, an inflammatory process develops;
• the inability to remove the accumulated urine reduces the functional ability of the kidneys. Urine retention in the absence of therapy provokes the development of a serious condition in which the bean-shaped organs do not work in full or cannot accumulate, filter and remove fluid. In the terminal stage of an acute one and transplantation of natural filters is required, until a donor is found, one will have to receive a chronic one - extrarenal blood purification from toxins and nitrogenous decay products.

It is important to know which factors increase the risk of urinary retention. The more attention a man pays to the health of the prostate, kidneys, bladder, the lower the risk of problems with the genitourinary system. Undertreated, chronic pathologies of the urinary tract and genital organs often provoke dangerous complications, including prostate cancer.

10 rules for the prevention of ischuria:

• Avoid hypothermia, frequent heavy lifting.
• Stop drinking hard alcohol, stop smoking. It is important to get rid of habits and exposure to poisons that impair the blood supply to important organs and tissues, reduce the elasticity of blood vessels that poison the body.
• Refuse to take medicines uncontrollably.
• Move more to prevent phlebitis of hemorrhoidal veins.
• Less nervous, in frequent stressful situations, take herbal sedatives, drink tea from lemon balm, valerian root, mint, chamomile in courses.
• Pay attention to signs of inflammation of the prostate.
• Every year to visit (even in the absence of discomfort in the urinary tract), donate, do, prostate,.
• Follow the rules for the prevention of inflammation after surgical treatment of pathologies of the genitourinary system.
• Prevent sexually transmitted diseases, use a condom.
• Empty the bladder in time, do not endure with a strong urge to empty the organ.

With the development of ischuria, men should know what to do to prevent dangerous consequences. Acute retention of urine often leads to intoxication, stretching of the walls of the bladder, in severe cases, rupture of an important organ is possible. It is important to know what the consequences of urinary retention are possible in the absence of adequate therapy. One of the negative manifestations is the deterioration of men's health, problems with potency. Measures to prevent ischuria are quite simple, compliance with the rules prevents many physiological and psychological problems.

Video. Specialist of the clinic "Moscow Doctor" about the causes and methods of treatment of urinary retention in men:

DEFINITION.

Acute urinary retention means a complete cessation of the act of urination with a full bladder.

ETIOLOGY AND PATHOGENESIS

Urinary retention can occur due to a number of reasons presented in Table.

REASONS FOR THE DEVELOPMENT OF ACUTE URINARY RETENTION.

CLINICAL PICTURE AND DIAGNOSTIC CRITERIA.

Patients suffer from overfilling of the bladder: there are painful and fruitless attempts to urinate, pain in the suprapubic region, the behavior of patients is extremely restless. Patients with diseases of the central nervous system and spinal cord react differently, who, as a rule, are immobilized and do not experience severe pain. When viewed in the suprapubic region, a characteristic bulge is determined due to an overflowing bladder ("vesical ball"), which, on percussion, gives a dullness of sound.

ALGORITHM FOR THE TREATMENT OF ACUTE URINARY RETENTION

With acute urinary retention, it is urgent to evacuate urine from the bladder.

Urine evacuation can be done in three ways:

1) bladder catheterization,

2) the imposition of a suprapubic vesical fistula, (cystostomy),

C) suprapubic puncture of the bladder.

In order to provide timely and qualified assistance, it is necessary to clearly understand the mechanism for the development of acute urinary retention in each individual case.

Bladder catheterization should be treated as a major procedure, equating it with surgery. In patients without anatomical changes in the lower urinary tract (diseases of the central nervous system and spinal cord, postoperative ischuria, etc.), bladder catheterization is usually not difficult. Various rubber and silicone catheters are used for this purpose.

The greatest difficulty is catheterization in patients with benign prostatic hyperplasia (BPH). With BPH, the posterior urethra lengthens and the angle between its prostatic and bulbous sections increases. Given these changes in the urethra, it is advisable to use catheters with Timan or Mercier curvature. With the rough and violent introduction of the catheter (especially when using a metal catheter), serious complications are possible: the formation of a false passage in the urethra and prostate gland, urethrorrhagia, urethral fever. The rise in body temperature with a tremendous chill (urethral fever) is due to the massive entry into the vascular bed through the damaged urethral mucosa of bacteria and their toxins, which is facilitated by urethrovenous reflux. Bacteremia can cause shock and urosepsis.

Prevention of these complications is careful observance of asepsis and catheterization techniques. With complex catheterization, it is more expedient to leave the catheter permanently (FOLI catheter), using the time of its stay for examination and preparation of the patient for a possible surgical intervention.

In acute prostatitis (especially with an outcome in an abscess), acute retention of urine occurs due to deviation and compression of the urethra by an inflammatory infiltrate and swelling of its mucosa. Bladder catheterization in this disease is dangerous and contraindicated

Acute urinary retention with bladder stones occurs when a stone wedged into the neck of the bladder or obturates the urethra in its various departments. Palpation of the urethra helps to diagnose stones. Anterior urethral stones are removed with tweezers or a forceps. If a strangulated stone is localized in the bladder neck or posterior urethra, an attempt should be made to move the stone into the bladder with a metal catheter, after which urination is restored. If these manipulations fail to restore urination, then as an emergency, a suprapubic puncture of the bladder with a needle is performed. When performed correctly, bladder puncture is safe and can be repeated. Suprapubic capillary puncture of the bladder is performed along the midline of the abdomen, retreating 2 cm from the upper edge of the pubic symphysis with tight filling of the bladder. In this case, the needle is inserted strictly perpendicular to the anterior abdominal wall, taking into account the thickness of the anterior abdominal wall until urine appears from the needle.

For urethral strictures that lead to urinary retention, an attempt should be made to catheterize the bladder with a thin elastic catheter. If catheterization was successful, the catheter is left for 2-3 days, antimicrobial and anti-inflammatory therapy is carried out. During this time, the swelling of the urethra usually disappears and urination can be restored. If catheterization is not possible, cystostomy should be performed, which will be the first stage of subsequent plastic surgery on the urethra.

Acute urinary retention is one of the leading symptoms in patients with urethral injury. In this case, bladder catheterization for diagnostic or therapeutic purposes is unacceptable. The patient should have an epicystostomy and drainage of a hematoma in the perineum. If there is no possibility to perform an urgent operation, the emptying of the bladder is carried out by suprapubic puncture.

The cause of acute urinary retention in elderly and senile women may be uterine prolapse. In these cases, it is necessary to restore the normal anatomical position of the internal genital organs and urination is restored (usually, without prior catheterization of the bladder).

Casuistic cases of acute urinary retention include foreign bodies of the bladder and urethra, which injure or obstruct the lower urinary tract. Emergency care is to remove the foreign body. The method of removal depends on the size and location of it, as well as on the presence of concomitant trauma to the bladder or urethra.

COMMON THERAPY ERRORS.

The absence of voluntary urination makes it necessary to differentiate acute urinary retention from acute renal failure - anuria. In the latter, there is no urge to urinate and the bladder is empty, as confirmed by percussion and ultrasonography. The presence of an acute inflammatory process in the lower urinary tract and prostate (, prostatitis), urethrorrhagia or urethral fever in patients with acute urinary retention is an absolute contraindication to bladder catheterization.

Acute urinary retention - the impossibility of self-
positive a:kta urination with overflowing
bladder. Urinary retention should be distinguished from

anuria, in which urination does not occur due to the lack of urine in the bladder. With urinary retention, the patient has a strong urge to urinate-emission, with anuria there is no urge.
Acute urinary retention can occur suddenly with “full health” or occur against the background of previous dysuric phenomena (increased frequency, difficulty urinating, sluggish, thin stream, feeling of incomplete emptying of the bladder after urination, etc.).
Chronic retention is distinguished from acute urinary retention, which develops gradually, over many months and even years.
If, when trying to urinate, the patient is completely unable to urinate, they speak of complete urinary retention. In those cases when, during urination, part of the urine is excreted, and some of it remains in the bladder, then they speak of incomplete urinary retention. The urine that remains in the bladder after urination is called residual urine.
Acute urinary retention occurs as a result of compression of the urethra, narrowing or blockage of its lumen, damage to the urethra, as well as a condition that causes a violation of innervation or a decrease in the tone of the muscles of the bladder.
The mechanisms for the development of acute urinary retention are diverse:
* violations of the innervation of the bladder, its sphincters and urethra;
* the consequences of mechanical obstructions to urine emission due to various diseases of the bladder, prostate and urethra;
* traumatic injuries of the bladder and urethra;
* Psychogenically conditioned acute urinary retention.

Urinary retention can be caused by
central nervous system (organic and
functional nature) and diseases of the urinary
fishing organs. For diseases of the central nervous
systems include tumors of the brain and spinal cord
ha, dorsal tabes, traumatic injuries with
compression or destruction of the spinal cord,
ria. Acute urinary retention is often seen in
56
postoperative period, including in young people. Such urinary retention is reflex in nature and, as a rule, is completely eliminated after several catheterizations.
However, most often acute urinary retention develops in some diseases and injuries of the genitourinary organs. These include diseases of the prostate gland (adenoma, cancer, abscess, atrophy, prostatitis), bladder (stones, tumors, diverticula, injuries, bladder tamponade, urinary infiltration), urethra (strictures, stones , trauma), the penis ("gangrene), as well as some paravesical diseases in women. This is a far from complete list of reasons that cause urinary retention.
Acute urinary retention is one of the symptoms, often severe, severe diseases or damage primarily to the prostate, bladder, urethra or central nervous system. With urinary retention, disturbances occur in the executive organs that carry out urination (bladder and urethra), in the mechanisms that control and regulate this act (nervous system) or as a result of diseases of other organs located near the urinary system (germination of cancer from the rectum to the bladder neck, cancer of the prostate urethra, prostate cancer, prostate abscess, paraurethral abscess, acute cavernitis, pelvic neoplasm, paraproctitis). Acute urinary retention is possible with poisoning, overdoses of certain drugs, in the postoperative period. And yet more often it is observed with prostate adenoma (Fig. 18).
Urinary retention is facilitated by overeating, cooling, prolonged sitting or lying down, disruption of the intestines, especially constipation, sexual excesses, "forced retention of urine, physical overwork and other" moments. All this leads to stagnation of blood in the pelvis, swelling of the enlarged prostate gland.
The clinical picture of acute urinary retention before
freely characteristic .. Patients complain of strong
pain in the lower abdomen (suprapubic region)
sti), frequent painful, fruitless urge to
urination, a feeling of fullness and fullness can
bubble. The strength of imperative urges in the urine
emission increases, quickly becomes intolerable
my sick. Their behavior is restless. Suffering from
overdistension of the bladder and infertile
torture to empty it, the sick groan, take
a variety of positions to urinate (sta-
kneel down, squat down) ^ put pressure on
area of ​​the bladder, compress the penis. Bo-
either subside, then repeat again and patients with
dreadfully expect their recurrence. Such conditions never happen with anuria, with acute urinary retention caused by a violation of the innervation of the bladder, as well as with a disease of the central nervous system.
On examination, especially in patients with malnutrition, a change in the configuration of the lower abdomen is determined (Fig. 19). In the suprapubic region, a swelling in the form of a spherical body, which is called<пузырным шаром>. Its surface is smooth, it is elastic, a dull sound is determined percussion over it. Palpation, as a rule, causes "an excruciating urge to urinate. Sometimes patients experience reflex inhibition of intestinal activity with bloating.





With urological diseases (prostate adenoma and urethral stricture), patients gradually have difficulty emptying. Its surface is smooth, it is elastic, a dull sound is determined percussion over it. Palpation, as a rule, causes "an excruciating urge to urinate. Sometimes patients experience reflex inhibition of intestinal activity with bloating.
urinary retention can be difficult. Let us explain this with a clinical example.
Diagnosis of the causes of acute urinary retention is based primarily on sufficiently characteristic complaints "and the clinical picture. In addition, when questioning the patient, some details can be revealed that contribute to the establishment of these causes. It is very important to pay attention to three anamnesis. on the nature of urination before the development of delay (free, difficult, frequent, rare, with straining, intermittent, etc.). It is necessary to specify the time of onset of the disease, its course. In those. In cases where this condition is not developing for the first time, the methods of treatment used and its results should be clarified. When questioning, it is important to obtain from the patient information about the amount of urine during urination before the delay, its type (transparency, the presence of blood, salts, color, etc.) and the time of the last urination. It is also advisable to clarify the presence of factors that contribute to urinary retention - the use of large amounts of liquid, beer, alcoholic beverages, the presence of inflammatory diseases of the urinary and genital organs, etc.
Thus, the patient's complaints, the data of the survey and examination allow us to determine urinary retention.
However, in some cases, to recognize an acute
It is more difficult to determine urinary retention, which proceeds according to the type of paradoxical ischuria. Parodoxal ischuria is a special form of acute incomplete urinary retention, in which urine is spontaneously excreted in drops from an overflowing bladder. The patient cannot empty the bladder. Do not confuse paradoxical ischuria with urinary incontinence. It's not the same thing. With true incontinence of urine, it flows immediately after it enters the bladder. In cases of paradoxical ischuria, the bladder wall is maximally stretched and "urine from the bladder is released in drops only when it overflows. If urine is released from such a patient with a catheter, then for some time (until the bladder overflows), it will not flow. As the filling of the bladder, when it overflows, its outflow will resume again drop by drop.Parodox ischuria often develops, gradually.
In urological diseases (prostate adenoma and urethral stricture), patients gradually have difficulty emptying the bladder. The latter loses its tone, its wall first thickens and then becomes thinner. In parallel with the progression of the disease and with a decrease in the tone of the detrusor, the bladder is not completely emptied and residual urine remains in it. Constant overflow of the bladder disrupts the work of his sphincter. Finally, a condition arises in which urine flows out of the bladder, as if from an overflowing glass, into which water continues to be poured in drops. Paradoxical ischuria can develop acutely. A similar condition occurs in case of trauma and some diseases of the spinal cord. In these cases, the innervation of the bladder and its sphincter, as well as the sphincter of the urethra, is most often disturbed.
Most often, especially in older men, the cause of acute urinary retention is prostate adenoma.
As the adenomatous nodes grow, the initial section of the urinary tract is compressed, bent in different directions, its lumen turns into a narrow gap, stretches in length, which creates great obstacles to the outflow of urine and contributes to the development her delay.Even before the complete retention of urine, patients develop and gradually develop other urination disorders: first, nighttime urination becomes more frequent, and then daytime. At the same time, there is difficulty urinating, especially in the morning. The jet - urine becomes more steep. For better emptying of the bladder, the patient has to strain.
With prostate adenoma, "acute delay" may occur unexpectedly, when the clinical picture of adenoma is mild or develops gradually. In the second case, it develops against the background of increasing violations of the act of urination, an increase in the amount of residual urine.
In cases where acute delay develops
against the background of relative prosperity, content in
bubble already 400-500 ml of urine causes painful
picture. In those cases where it develops
Gradually, the bladder seems to adapt,
it stretches, its capacity noticeably increases. Ta-
which bladder can contain 1-2 liters and even
more urine. In such patients, overflowing urine
the howling bladder, especially in thin people, is sometimes visible to the eye in the form of a tumor that bulges in the suprapubic region. Often its dimensions are huge, reaching the level of the navel and even higher. Regardless of how urinary retention has developed (suddenly or gradually), if it has come, few patients behave relatively calmly, and even then, until the bladder is overdistended. The vast majority of patients do not tolerate overdistension of the bladder at all and suffer greatly from it.
In the diagnosis of prostate adenoma, an important place belongs to the study of the prostate gland through the rectum. Adenoma is characterized by an increase in the gland with the preservation of a densely elastic consistency and a smooth surface.
The clinical picture of gland cancer differs little from an adenoma. The latter can also lead to acute urinary retention, although less frequently than adenoma.
Cicatricial narrowing of the urethra as a result of previous inflammation of the urethra or trauma can also lead to acute urinary retention. Unlike prostate adenoma, this disease and associated urinary retention can occur at any age. The symptoms and clinical manifestations are very similar to those observed "with adenoma. Due to a mechanical obstruction, the outflow of urine created by the stricture of the urethra leads to expansion of the bladder, atrophy of its muscles, residual urine appears, if which gradually increases.The stream of urine becomes sluggish, thin, thready, and urination is slow.Finally, when there is a significant obliteration of the urethra with scar tissue, acute urinary retention develops.
Bladder and urethral stones can also cause acute urinary retention. The leading symptom of this disease is pain and frequent urination. These phenomena are aggravated by movement, as well as during physical exertion. The patient feels better at rest.
Violation of the act of urination with bladder stones largely depends on the position of the stone. Often, when urinating, there is an intermittency of the urine stream. If the stone is wedged into the internal opening of the urethra and completely closes it, a picture of acute urinary retention develops. This is observed more often when the patient empties the bladder while standing. When you change the position of the body, the stone can move back into the bladder and urination in this case is restored. If the stone descended outside the bladder into the urethra, I completely closed its lumen, then acute urinary retention is persistent.
A tumor of the urethra as the cause of urinary retention can be quite difficult to recognize. It is characterized by a gradual development without obvious signs of the disease at the onset of the disease. Purulent, and then bloody discharge from the urethra, frequent urge to urinate, its increase, weakening of the urine stream and other disorders can turn into urinary retention.
Acute urinary retention can be caused by bladder tumors. A villous tumor growing on a thin stalk and located at the neck of the urinary bladder can close the internal opening of the urethra and lead to urinary retention. In case of bladder cancer, the cause of urinary retention can be both the germination of the neck of the bladder by a tumor, and massive bleeding with the formation of blood clots. It should also be borne in mind that blood in the bladder with the formation of clots is not observed only with its tumors, but can also occur with severe renal bleeding, bleeding from the prostate gland, etc.
As a rule, acute urinary retention develops with spinal cord injury.
As mentioned above, acute urinary retention is not so rare that it can occur after various operations. In these cases, urinary retention is reflex in nature and is partly associated with a decrease in the participation of the anterior abdominal wall in urination. It should also be taken into account that some people in the supine position cannot urinate even without surgery, and even more so after surgery. In older people with prostate adenoma, any operation can contribute to urinary retention. As a rule, with such urinary retention after one or two catheterizations, urination is completely restored.
64
The trauma of the genitourinary organs, as the cause of the development of acute urinary retention, will be discussed in detail in a special section.
Despite the variety of causes and conditions that cause acute urinary retention and a significant number of diseases in which it occurs, recognizing it is not so difficult. You can talk about it if at least 10-12 hours have passed since the last urination and there is an appropriate clinic.
Urgent medical measures for acute urinary retention consist in the urgent emptying of the bladder. Urinary retention is unpleasant for patients not only because it causes excruciating pain, painful urges, discomfort, but also because it can lead to serious complications - inflammation of the bladder, kidneys, a sharp change in the condition of the bladder wall, its thinning up to until break.
Emptying the bladder is possible by three methods: bladder catheterization, suprapubic (capillary) puncture, and epicystostomy, mainly trocar. The most common and practically safe method is bladder catheterization with soft rubber catheters. It should be borne in mind that in a significant number of cases, acute urinary retention can be eliminated by catheterization of the bladder alone by leaving a permanent catheter or suprapubic puncture of the bladder for a short time (3-4 days). Catheterization is indicated if about half a day has passed since the last urination. However, the need for it may arise even earlier. If the act of urination is not restored after a while (10-12 hours), it may be necessary to re-catheterize. As a rule, three to four catheterizations per day are sufficient.
The presence of purulent inflammation of the urethra (urethritis), inflammation of the epididymis (epididymitis), the testicle itself (orchitis), as well as an abscess of the prostate gland, is a contraindication for catheterization. It is not indicated for trauma to the urethra. It is very important when catheterization to prevent urinary infection.All items in contact with the patient's urinary tract, _- and "instruments, underwear, dressings, solutions that are introduced into the bladder and urethra, must be sterile.
Bladder catheterization with soft or elastic catheters in acute urinary retention in most cases is easy and the catheter is freely passed into the bladder.
In all cases, the beak of the catheter should be
raised upwards and slide along the anterior steak of the urethra
or it should be carefully turned in the side
directions to bypass lateral displacements
static urethra. Forced insertion of a catheter
ra is unacceptable, since this causes injury
urethra and after such catheterization, bleeding from the urethra (urethrorrhagia) or an increase in body temperature to 39-40 ° C with acute illness (urethral fever) is possible.
To prevent urethral fever, before catheterization and within one or two days after it, antibiotics are prescribed for preventive and therapeutic purposes (levomycetin 0.5 g 4 times a day, neo1m "icin sulfate - 0 each, 25 g 2 times a day, tetracycline "0.1 g 6 times a day, erythromycin 0.1 g 6 times a day, etc.), furadonyan 0.1 g 4 times a day, urosulfan 0 5 g 6 times a day. Against the background of the developed urethral fever, the administration of medicinal substances through the mouth is not enough, and so it is necessary to use powerful drugs with a wide spectrum of antibacterial action for "intramuscular" administration (penicillin, streptomycin, methicillin, pentrexil, etc. .) alone or in combination.
At the same time, you should prescribe plenty of fluids, heart medications, and in severe cases, subcutaneous or intravenous infusions of physiological saline solution, 1-2 liters of 5% glucose solution.
Metal catheter for urinary catheterization
the first bubble can only be used as a last resort
case and with great care. This procedure
_not "simple and requires certain skills and experience. Any rough and violent introduction of a metal" catheter can damage the urethra, sometimes with the formation of false passages.
Urinary retention "after operations that were not performed on the organs of the urinary system, most often has a reflex origin or is due to a violation of the coordinated relationship between the detrusor" and the sphincters of the bladder and urethra. In case of urinary retention after appendectomy, gastric resection, operations on the liver, biliary tract, hernia repair and other operations that do not have close contact with the "urinary organs, assistance should begin with a set of measures prior to catheterization. In this the complex "includes giving the patient a sitting position or an attempt to urinate in a standing position (depending on the condition of the patient), running water from the tap, leaving the patient alone in the ward (some patients cannot urinate in public), sa. the suggestion that the delay is temporary and should go away on its own. When patients are excited in such cases, trioxazine is prescribed (0.3 g 3 times a day), seduxen (0.005 g - 2 times a day). You can assign a heating pad to the bladder area. If urination is not restored, prozerin, pilocarpine, or intramuscularly dihydroergotoysin (1 ml of a 0.03% solution) are injected subcutaneously. Only if all of the above measures fail, catheterization is used. also on the rectum, female genital area, spinal cord or brain without catheterization, as a rule, it is not possible to empty the bladder.
In cases where catheterization of the bladder fails or it is contraindicated (for stones, injuries of the urethra), one should resort to suprapubic capillary or trocar puncture of the bladder.
Before performing a suprapubic puncture, you need to make sure that the bladder is really full of urine - it protrudes high in the suprapubic region, a dull sound is percussion above it. If necessary, the capillary "puncture is repeated. Usually, the need for this occurs 10-12 hours after the previous puncture. If there is a need for repeated and prolonged drainage of the bladder, a trocar epicystostomy should be applied.
Epicystostomy (suprapubic vesical fistula) in case of acute urinary retention should be applied only under strict indications. Absolute indications are ruptures of the bladder and urethra, as well as acute urinary retention, occurring with the phenomenon of azotemia and urosepsis.
Patients with acute urinary retention should be treated
pay special attention. Doctor, all medical
staff with their behavior, calm and
with a thoughtful approach to the patient, everything must be done,
in order to positively influence the psyche of pain
and to help alleviate feelings of fear. Feel-
palpation and palpation are necessary "but to be done gently, without
special efforts and without causing pain; catheterization
perform the bubble so that she brings "and
68
moral and physical relief to the patient. If the catheter is left in the urethra for some time (permanent catheter), it needs appropriate care and supervision. Once the indwelling catheter is in place, make sure that urine flows through it. This largely depends on how correctly the catheter is placed (Fig. 20). If the discharge of urine stops, sterilely inject 10 ml of furatsil:in solution into the bladder and see that it all immediately goes back. Such washing of the catheter is carried out in order to make sure that it is passable for liquid, and, consequently, for urine. Clogging of the catheter with blood clots, salts is easily eliminated by washing. If the catheter has left the bladder, then during flushing, fluid may flow back between the catheter and the wall of the urethra. In this case, it should be inserted deeper and re-fixed.
After some time after fixing the catheter to the head of the penis, it is necessary to examine the head and clarify whether the penis is compressed, whether it is swollen, cyanotic, or painful. Especially one should be attentive and careful in this regard to persons with reduced sensitivity of the genital organs (with spinal cord injury).Decrease or loss of sensitivity of the penis does not allow the patient to feel pressure and present appropriate complaints.In such cases, even necrosis of the glans penis is possible.
A permanent catheter, in addition to monitoring its work, requires some care: its tip should not be in the flowing infected urine, the fixing bandage must be cleaned of purulent deposits, changed more often. -ters with inflatable cans.
At the medical center of the regiment, in case of acute urinary retention, emergency care consists in catheterization of the bladder with a soft catheter, and in case of obstruction and damage to the urethra, in the capillary puncture of the bladder. Patients are subject to urgent hospitalization.
In a separate medical battalion and a garrison hospital, emergency care should be built taking into account the causes of acute urinary retention. With reflex urinary retention, one should start with the use of the simplest methods - giving the body a habitual position, creating a splash of water, heating pads on the stomach, perineum, injections of pilocarpine (1% solution - 1 ml), prozerin (0.05% solution - 1-2 ml), aceclidine (0.2% solution - 1 ml); magnesium sulfate (0.25% solution - 5-10 ml), intravenous administration of hexamethylenetetramine (40% solution - 10 "ml). If there is no effect, catheterization with a "soft or elastic catheter. The use of a metal catheter should be careful and gentle. In case of difficulty in passing the catheter, capillary puncture should be used. It is necessary to resort to it, etc., and acute urinary retention after trauma and obstruction of the urethra due to strictures, tumors, abscesses and acute inflammation of the prostate gland, stones and foreign bodies of the urethra.
In surgical departments, if it is not possible to empty the bladder by the listed methods, they resort to trocar epicystostomy or the imposition of a urinary fistula in the usual way.
In case of tamponade of the bladder with a blood clot, an attempt is made to evacuate them using a large metal catheter and Janet's syringe. At the same time, hemostatic agents are used. .
In a specialized department, emergency care for acute urinary retention is provided in full, based on the causes of its occurrence.
With significant strictures, the urethra produces
bougienage with filiform bougie leaving one
many of them for a few days before recovery
micturition; with a stone and a foreign body in the urethra
apply the extraction of it with a loop, tongs or pro-
push bujo "m into the bladder, and if this is done
it is impossible to lay - it is removed by urethrotomy. When there-
ponade of the bladder with blood is removed
clots using an evacuator catheter and syringe
Janet, aspirator, Dormia loops. In the presence of cereal
dense and dense clots are crushed beforehand
are examined with a mechanical lithotripter. Overlay over-
pubic vesical fistula, as a rule, is produced by the method of troa "car puncture. After the elimination of acute urinary retention, its etiological factor should be established and planned treatment of the detected disease should be carried out.

Acute urinary retention - this is the name of the condition when a person feels strong, but independent micturition is impossible. It is worth limiting this pathology from anuria, in which urine ceases to be produced and the organ remains empty, as a result of which urination is impossible.

With urinary retention, the bladder is filled to the limit, so a person urgently needs emergency help from qualified doctors to alleviate the condition. Consider what causes this pathology, by what symptoms it can be recognized and how acute urinary retention is treated.

Acute urinary retention can be triggered by various factors in children, adults and the elderly. Unfortunately, a person at any age is not protected from the risk of developing this pathology. Neurogenic causes of urinary retention include:

• herniated intervertebral discs;
• dorsal dryness;
• injuries/tumors of the spinal cord or brain;
• myelitis;
• multiple sclerosis.

Mechanical causes of acute urinary retention:

• phimosis;
• sclerosis of the neck of the bladder;
• swelling of the urethra or neck of the bladder;
• stricture, abnormal development of the urethra;
• neoplasm localized in the lower urinary tract;
• blood clots;
• a foreign body in the bladder (stone) that blocks the flow of urine into the urethra.

There are also functional causes when reflex disorders of the bladder functions develop. Pathology develops as a result of:

1. Low ambient temperature.
2. Surgical intervention on the rectum or perineum.
3. Strong alcohol intoxication.
4. Prolonged stay of a person in a lying position (recovery period after surgery, paralysis of the limbs, etc.).
5. Prolonged stress.
6. Fright.

Acute urinary retention can develop due to the intake of certain medications: anticholinergics, narcotic painkillers, tricyclic antidepressants, and others. There are cases when, in older people, acute urinary retention was caused by injections of antispasmodics.

Common causes of pathology in men

Urinary retention in men often develops as a result of acute prostatitis, adenoma and malignant tumor of the prostate. Usually, an acute condition is preceded by a number of symptoms that accompany the described pathologies: frequent nighttime urination, sluggish urine stream, feeling. In such cases, surgical treatment is often required.

If acute urinary retention was caused by acute prostatitis, the man will be disturbed by weakness, nausea and other signs of intoxication. In this case, pain will be caused not only by overflow of the bladder, but also by inflammation of the prostate.

Causes of pathology in women

Acute urinary retention can be caused by the following factors:

• prolapse of the uterus;
• childbirth, especially prolonged or complicated;
• surgery on the genitals in the postpartum period;
• hysteria - a mental illness that affects mainly women;
• tumor of the uterus or rectum.

In girls, urinary retention can also be associated with the features of the hymen. If it looks like a solid plate, then during the onset of menstruation, the discharge accumulates and a hematocolpometer develops when the urinary tract and bladder are compressed. In this case, acute urinary retention occurs.

In medical practice, there are cases when pregnancy became the cause of urinary retention. This can happen when the uterus begins to grow rapidly and move, thus blocking the urinary tract. If there is a cervical pregnancy (ectopic), then due to the expansion of the cervix, the urinary tract is compressed and urinary retention, bleeding and other dangerous symptoms occur, indicating the need for medical attention.

What causes it to develop in children?

In boys, a common cause of this pathology is called phimosis - a narrowing of the foreskin, when only a small hole remains in it, which prevents the timely and complete emptying of the bladder. Acute urinary retention will occur if the narrowing develops into paraphimosis when the urethra closes completely. In this case, the only treatment is surgery.

In girls, this condition can be caused by prolapse of a cyst of the distal ureter into the urethra. In addition, children are particularly susceptible to various injuries that they receive during active games, so urinary retention can be caused by perineal injuries.

Symptoms

Symptoms of acute urinary retention are clearly expressed:

• very strong urge to empty the bladder;
• when you try to make a micturition, drops of blood appear from the urethra;
• severe pain in the pubic area and slightly higher;
• bursting sensations in the lower abdomen;
• voluminous bladder: a protrusion appears in the suprapubic region, it is densely elastic to the touch, severe pain is felt on palpation;
• if there has been a rupture of the bladder or urethra, traumatic shock occurs.

Sometimes acute urinary retention is preceded by the following symptoms:

• sleep disturbance;
• general weakness;
• frequent urge to empty the bladder, as well as at night;
• nausea, vomiting;
• lack of appetite;
• increase in body temperature;
• constipation.

It is important to call such manifestations to the doctor when collecting an anamnesis, so that he can correctly diagnose and prescribe adequate treatment.

Diagnostics

Acute urinary retention is easily diagnosed during the initial examination of the patient. In a place located in the middle of the distance between the pubic joint and the navel, an arcuate bluntness is determined when tapping, facing upwards. Percussion of the suprapubic region is also performed, when a dull sound is well heard.

After providing first aid, it is often carried out:

1. Ultrasound of the pelvic organs.
2. Excretory cystourethrography.
3. Retrograde urethrography.
4. intravenous pyelography.
5. Computed tomography.

Such diagnostic measures are necessary to clarify the diagnosis and the provoking cause, as well as to prescribe a suitable treatment.

First aid to the sick

Acute urinary retention requires emergency care, which consists in draining the bladder through catheterization, which leads to complete emptying of the organ. This technique can only be performed by a physician. The procedure is performed using a metal or flexible catheter:

• for catheterization of women, a metal catheter with a soft tip is used;
• for men, it is more appropriate to use a flexible catheter, the diameter of which is identical to the lumen of the urethra.

In both cases, the catheter is liberally lubricated with petroleum jelly or glycerol, gently inserted into the urethra until urine flows from the other end of the tube into a prepared tray. No more than two catheterization attempts are made, if none of them is successful, the patient is urgently taken to the hospital.

There are a number of contraindications for this procedure:

• urethral injury;
• the presence of stones in the urethra;
• prostate abscess;
• acute prostatitis;
• orchitis;
• acute urethritis.

If standard catheterization could not be carried out or there were contraindications for this, cystostomy is performed under stationary conditions. To do this, a puncture is made in the bladder area, through which an elastic rubber tube is inserted into the organ. As a result, urine flows from the bladder constantly until the organ function is fully restored.

When for a long time, a prerequisite is regular washing of the organ with antiseptic solutions and the patient taking broad-spectrum antibiotics. Such measures will prevent the attachment of infection.

If the pathology was caused by reflex disorders, the first aid is taking a warm bath. This procedure will relax the urethral sphincter, after which the patient will be able to empty the bladder on their own. For the same purpose, a dose of pilocarpine or prozerin can be urgently administered intramuscularly, and novocaine (1% solution) intraurethral.

A big mistake of patients with urinary retention is self-medication, especially taking diuretics. Such therapy can only aggravate the patient's condition.

Treatment

The first and main stage in the treatment of acute urinary retention is the drainage of the bladder to empty it completely. Further therapeutic tactics depend on the cause that provoked this pathology.

In 98% of such cases, patients are prescribed α-blockers - tamsulosin or alfuzosin. To prevent the development of an infectious process, patients need to take antibiotics Furadonin, Ampicillin, Nitroxoline, Cephalosporin or other drugs prescribed by the attending physician.

Acute urinary retention caused by acute prostatitis requires antibacterial and anti-inflammatory treatment. Additionally, sitz warm baths, antipyrine enemas, belladonna suppositories and warm compresses on the perineum are prescribed. As a rule, a day after the exacerbation, urination returns to normal.

If there was a neurogenic cause of urinary retention, the drugs Aceclidin, Prozerin, solutions of Atropine sulfate and Papaverine hydrochloride are used. Such therapy allows you to eliminate the atony of the bladder detrusor and quickly cope with the problem.

When the delay was provoked by severe stress, fright, nervous strain or similar factors, patients are prescribed bed rest, warm baths and sedatives.

With difficulty urinating as a result of the formation of blood clots, it is necessary to flush the bladder with isotonic sodium chloride solution.

If there was a bladder injury, the patient is prescribed hemostatic, detoxification, antibacterial and anti-shock therapy.

In some cases, surgery is necessary:

• with rupture of the bladder or urethra;
• when phimosis occurs;
• if a man has been diagnosed with prostate hyperplasia, its tumor;
• when a neoplasm of any nature is detected in the pelvic area in women;
• in the presence of stones in the urethra or bladder.

If acute urinary retention occurs, you should not hope that the problem will “resolve” itself. Self-medication can lead to sad consequences in the form of urosepsis or rupture of the bladder. Therefore, do not be shy and call an ambulance - and your problem will be solved competently and without consequences.