The Management of Acute and Chronic Retention of Urine: ISC versus Indwelling catheterisation. - PowerPoint PPT Presentation

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The Management of Acute and Chronic Retention of Urine: ISC versus Indwelling catheterisation.

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The Management of Acute and Chronic Retention of Urine: ISC versus Indwelling catheterisation. Roisin Hart Senior Urology Nurse Specialist Winchester – PowerPoint PPT presentation

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Title: The Management of Acute and Chronic Retention of Urine: ISC versus Indwelling catheterisation.


1
The Management of Acute and Chronic Retention of
Urine ISC versus Indwelling catheterisation.
  • Roisin Hart
  • Senior Urology Nurse Specialist
  • Winchester

2
Urinary Retention
  • The inability to voluntarily void urine

3
Categories of Urinary Retention
  • Obstructive
  • Infectious Inflammatory
  • Pharmacologic
  • Neurologic
  • Other

4
Causes of Urinary RetentionObstructive
  • Benign prostatic hyperplasia
  • Strictures
  • Bladder calculi
  • Faecal Impactation
  • Phimosis / paraphimosis
  • Benign/malignant pelvic masses
  • Meatal Stenosis

5
Causes of Urinary RetentionObstructive
  • Organ prolapse eg cystocele, rectrocele, uterine
    prolapse
  • Pelvic mass gynae malignancy
  • Uterine fibroid / ovarian cyst
  • Retroverted impacted gravid uterus
  • Foreign bodies

6
Infectious and InflammatoryCauses
  • Prostatitis
  • Prostatic abscess
  • Balantitis
  • Cystitis
  • Acute vulvovaginitis
  • Bilharziasis
  • Herpes simplex virus

7
Pharmacologic causes
  • Drugs with anticholingeric properties eg
    tricylic antidepressants (amitriptyline)
  • Opioids
  • Sympathomimetic drugs eg oral decongestants
    containing Ephedrine ( Sudafed)
  • NSAIDs in men
  • Antiparkinsonian agents (levodopa)
  • Antipsychotics (chlopromazine)
  • Muscle relaxants (Baclofen)

8
Neurologic cause
  • AUTONOMIC OR PERIPHERAL NERVE
  • Diabetes mellitus, Guillain-Barre syndrome
  • Pernicious anaemia, radical pelvic surgery
  • BRAIN
  • CVA, MS, Tumour, Parkinsons disease, concussion
  • SPINAL CORD
  • Haematoma / abscess / tumour, Cauda equine, spina
    bifida occulta

9
Other causes
  • Post-op complications
  • Pregnancy-associated retention
  • Trauma eg penile fracture or laceration
  • Idiopathic detrusor failure

10
Presentation of AUR
  • Sudden inability to pass urine
  • Suprapubic pain which typically causes spasm
  • Patient is acutely distressed
  • Often longer history of bladder outflow symptoms
  • Bladder is visible,tender and palpable
  • Patient is typically male

11
Effects of AUR
12
Chronic Retention of Urine
  • Completely different maybe painless
  • Incomplete emptying
  • Often deny LUTS, nocturnal enuresis
  • Large bladder, ? uraemic, ?anaemic, ?fluid
    overloaded
  • Large residual volume
  • May diurese
  • Bladder drainage may cause haematuria

13
Acute or chronic?
  • Large over distended bladder
  • Pressure on kidneys and surrounding organs

14
Acute on Chronic Retention
  • Painful inability to empty bladder
  • Previous incomplete bladder emptying
  • Large volume on catheterisation

15
Normal and overfilled bladder
16
Management of AUR
  • Decompression by Catheterisation
  • Residual Volume lt 800mls
  • UES and Creatinine normal
  • Systemically well
  • Home with catheter
  • Follow-up plan

17
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18
Management of Chronic Retention
  • Admit for observation including fluid balance
    chart
  • Check renal function
  • Image upper tracts
  • Manage post obstructive diuresis
  • TWOC maybe unsuccessful
  • May need TURP but may have irreversible detrusor
    failure
  • ISC an option or LTC

19
Acute or Chronic
20
Complications of Chronic retention of urine
  • Bilateral Hydronephrosis
  • Renal Inpairment
  • Infections
  • AUR
  • Stones

21
Hydronephrosis
22
Further Management
  • Varying local practices
  • GP/DN? catheterise?TWOC at home
  • GP/DN ?catheterise ? refer to urology
  • Attend AE ? catheterise ?send home
  • Attend AE ?catheterise?admit?TWOC

23
Urethral vs. Suprapubic catheterisation
  • URETHRAL
  • Usually quick easy
  • Competent staff readily available
  • Infection easily introduced
  • Risk of Stricture
  • SUPRAPUBIC
  • technical procedure
  • Fewer staff competent
  • Concerns over safety
  • Easier to TWOC
  • Reduce risk UTI
  • Reduce stricture

24
Urethral Catheterisation
  • Check for sepsis prior to catheterisation
  • Ensure correct catheter selection
  • Always use an aseptic procedure
  • Never force catheter against resistance
  • Never inflate balloon in urethra
  • Know your limitations
  • Always record details and residual volume
  • Think Paraphimosis

25
Which Catheter?
  • Nelaton Catheters
  • (ISC)
  • Foley catheters
  • (Indwelling)

26
Complications of Indwelling Catheter
  • Infection
  • Irritation / Erosion
  • Injury
  • Stricture and False passage
  • Stones / Encrustation causing blockage
  • Spasm / Bypassing / Expulsion
  • Malignant change
  • Haematuria

27
Complications of Indwelling catheter (cont)
  • Insertion difficulties
  • Removal difficulties- non deflation
  • Pain or discomfort
  • Catheter expulsion
  • Infected peri-urethral glands causing
    abscess/fistula
  • Reduced bladder capacity
  • Reduced mobility

28
Benefits of Indwelling catheter
  • Continence
  • Preserves renal function
  • May reinstate social independence
  • Prevents high pressure bladder

29
Benefits of ISC
  • Lower risk of infection
  • Retains bladder capacity
  • Allows normal function
  • Protects renal function
  • Avoids encrustation

30
Benefits of ISC (cont)
  • Maintains body image
  • Promotes independence
  • Increases morale and self esteem
  • Reduces dependence on health professionals
  • Maintains sexual function
  • Improves quality of life

31
Limitations of ISC
  • May not be possible in those with
  • Profound physical disabilities or poor manual
    dexterity.
  • Psychological barriers to using technique.
  • Small bladder capacity.
  • Inadequate urethral pressure.

32
ISC or Indwelling catheter
  • Not mutually exclusive
  • Depends on individuals needs
  • Patient choice

33
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