Acute retention of urine
Acute retention of urine is one of the commonest urologica! emergencies that are met with by general practitioners and casualty officers. In the past ten years, 333 cases of acute retention of urine have been admitted to the University Surgical Unit, Queen Mary Hospital. It is the aim of this article to analyse the frequency of the causes of retention in these 333 eases, their investigations and subsequent management.
it shows that of these 333 cases, 225 cases are obstructive in nature.
They are due to obstructive lesions arising from the bladder neck to the external urethral meatus. 11 are due to neurogenic lesions arising from the spinal cord or the central nervous system. 97 cases are due to causes unrelated to diseases of the urinary tract; the retention is due to pain causing reflex inhibition of micturition. By far the commonest lesion is benign prostatic hypertrophy and there are 90 cases out of a total of 225 cases of retention. This is followed by urethral stricture. Among the least common causes of urinary obstruction is carcinoma of the bladder. There are only 4 in this series. All of them are carcinoma arising from the base of the bladder and extending to the bladder neck.
There are 90 cases of Benign Prostatic Hypertrophy
.It is common in patients above the age of 60. The enlargement of the prostate gland may involve the lateral or median lobes. They all give history of frequency of urination, dribbling, difficulty in initiation and dysuria if cystitis supervenes. The retention is often precipitated by exposure to cold, taking excessive alcohol or superimposed infection of the bladder. Physical examination on admission includes the general examination of the patient especially for features of uraemia. The blood pressure must be checked.
special attention is paid to cardio-pulmonary system. Rectal examination usually reveals an enlarged prostate with prominent median groove. A full bladder may mask the actual size of the gland. Hence the size of the prostate can only be gauged after the bladder is emptied. Median lobe enlargement alone may not give obvious palpable enlargement. In such cases, the diagnosis has to be made on Panendoscopic examination.
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