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Urinary retention

The urine delay, i.e. inability to empty a full bladder, often meets as a critical situation. Irrespective of an etiology the urine delay can render an adverse effect on a bladder and on the top departments of uric ways, no less than on all fluid and electrolyte the organism status.

Clinical displays

Though the urine delay is characterized by inability of the patient to empty the full bladder, sick can feel (or not to feel) that the bladder is overflowed. The chronic delay of urine most often meets at patients neurogenetic dysfunction of a bladder and prostatitis. The urine incontience can proceed and day and night. In a standard case the person doesn't realize that the bladder is overflowed, though some patients with a chronic delay of urine show complaints to frequent desires to an urination and nocturia. In rare instances the stomach increase can be a unique symptom. Patients with a sharp delay of urine usually feel a restretching of a bladder and discomfort in this area.

The most frequent reasons of a delay of urine:

  • Obstructive
  • Primary insufficiency detrusor
  • Structure of an urethra
  • Detrusor areflexia
  • Increase prostate glands
  • Multiple sclerosis
  • Malignant tumor in the bottom departments of an urinogenital path
  • Iatrogenic a trauma at operation on a backbone or an abdominal cavity
  • Malignant tumor in a small basin
  • Spinal cord trauma

  • Bladder stones
  • Myelomeningocele
  • Foreign matter
  • Blood clot
  • Valves of a back part of an urethra
  • Urethrocele

At men of middle age, in the anamnesis can be gonococcal urethritis and (or) urination infringement. After prostatectomy can develop stricture the urethral channel and (or) a contracture of a neck of a bladder that can cause a sharp delay of urine. The patients accepting anticholinergic preparations under other indications (for example, a syndrome of irritation of a thick gut), also get to risk group as the urine delay can be provoked pharmacological the reasons.

Diagnostics

The diagnosis put at physical inspection. Thus traditionally palpate a bladder over a pubis. It can act over symphysis on 1-2 sm and more. The information can be received and at ultrasonic of an abdominal cavity after an urination or catheterization and measurement of volume of residual urine. As the bladder starts to act over symphysis, begins possible to catch border of an arrangement of its dome. If after the strengthened urination in a bladder all the same there are more than 200 ml of urine do a conclusion about an inefficient emptying of a bladder.

Treatment

At not complicated prostatitis carry out catheterization a standard urethral catheter. If not traumatic introduction catheter is impossible, it testifies to presence stricture urethras or contractures of a neck of a bladder. The bent tip of a catheter passes through expansion in the field of a comb prostate parts of an urethra easier and with smaller risk injury, than a standard catheter with a direct tip. If usual catheterization any doctor carrying out of the further researches with use of tools demands attraction of experts spends. The special catheter with a conductor (at a stenosis in the field of an external aperture of an urethra) is necessary for entering very carefully since at its wrong carrying out it is possible to injure an urethra. After successful introduction of a conductor of the minimum size to it attach a special catheter, carefully enter it into a bladder and leave in a bubble at 24 o'clock to achieve expansion of the narrowed part of an urethra.

The suprapubic puncture of a bladder is more effective urgent medical manipulation, than use of catheters with conductors.

Techniques of manipulations

Catheterization urethras

It is necessary for patients to moisten well an urethra with gel with anesthetizing substance. Using a syringe with the catheter put on it, it is necessary to enter into an urethra of gel of 10-20 ml with an antiseptic tank. After the catheter is slightly entered in exterior an aperture of the urethral channel, all urethra slowly fill with gel. It is necessary to take a penis head from men the left hand (for the right-handed person) and to translate a member in position at right angle to a pubis. Then an urethral catheter enter into an urethra the right hand. Some resistance is usually carried out during overcoming external urethral sphincter. To achieve a relaxation sphincter it is possible by gradual strengthening of pressure while the patient deeply breathes through the mouth. If necessary instead of a catheter with a standard tip enter a catheter with the bent tip. Catheter strengthen in a bladder by cylinder inflating on it gallbladder the end (enter through the second channel of a catheter of a sterile liquid of 5 ml) and catheter pullings up outside until the cylinder "not will hang" on a bladder neck. The catheter is necessary for attaching to a drainage with cargo then to adjust monitoring of branch of urine throughout 24 hours. After unsuccessful attempt catheterization a bladder it is not necessary to do repeated, more aggressive attempts.

Suprapubic trocar cystostomy

First of all it is necessary to confirm the diagnosis of a delay of urine. For this purpose a forward belly wall and a skin in a point located on 2 sm above pubic symphysis, infiltrate 1% a lidocaine solution. Then a thick needle with the attached syringe on 10 ml enter through the anesthetized skin into the filled bladder. At a pandiculation on itself of the piston in a syringe urine should by suction. After that a needle take and trocar carry out cystostomy.

Sometimes at patients the delay of urine because of a congestion in a bladder of clots of blood is marked. The increased bladder is thus palpated.

The most frequent reasons of formation of clots of blood in a bladder:

  • Recently transferred operation on bodies of urinogenital system
  • A malignant tumor of urinogenital system
  • Beam therapy of area of an abdominal cavity and (or) perineums
  • A trauma
  • Chemotherapy
  • Bleeding diathesis

For an emptying of a bladder at the patient with a delay of the urine caused by clots of blood, the big catheter of Foleja (№22 or more) is necessary. For extraction of clots it is necessary to wash out a bladder a sterile isotonic solution of chloride of sodium by means of a syringe on 60 ml. If after such washing it is not possible to receive good outflow of urine, long washing with application three luminal a catheter of Foleja can be demanded.

After adjustment corresponding drainage a bladder it is necessary carefully monitor volume urinary. At a chronic delay of urine (at which increase of level of urea and a creatinine in blood is usually observed) the postobstructive type diuresis finally is formed. Therefore patients with a chronic delay of urine accept obligatory hospitalization. At patients with a chronic delay of urine can develop nephrogenic insipidus.

After reduction of degree of obstruction of uric ways it is necessary to define the reason, its causing. It is possible to apply such techniques to statement of the correct diagnosis, as retrograde urethrography, excretory urethrography and intravenous pyelography.

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