Anatoly Shishigin

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In men, quite often a pathological condition occurs when urination in the presence of fluid in the bladder is impossible, but the urge to deurinate is quite intense. This is called chronic urinary retention.

In the International Classification of Diseases (ICD 10), the disease code corresponds to R33 and is described as an overflow of the bladder with a pronounced inability to empty itself. Such diseases occur in many cases, with the exception of neurological diseases and spinal injuries, in which such a phenomenon is considered natural.

Classification

Ischuria, chronic urinary retention in men, is of 3 types:

• ischuria in an acute form, developing extremely rapidly, within a few hours. The patient feels severe pain in the lower abdomen, a sharp urge to deurinate, but it is not possible to release the fluid, even if he strains;
• ischuria in a chronic form, in which deurination is possible, but some fluid remains in the bladder, which is a deviation from the norm. There is no urgent urge to urinate;
• ischuria of the paradoxical type, when involuntary urinary incontinence occurs when the bladder is full. This is caused by excessive stretching of the valves located in the urethra.

Mechanical obstacles

1. Injury to the urethra;
2. Neoplasms in the prostate gland, malignant or benign;
3. The appearance of stricture in the urethral canal;
4. A tumor in the urethra or rectum that puts pressure on the urethra;
5. Formation of stones in the urethra or bladder;
6. Pathology of the foreskin, in which a narrowing or phimosis is formed, preventing the entire head from opening;
7. Abnormal development of the urethral canal;
8. Urinary tract infection, accompanied by narrowing of the urethral canal and swelling.

Disturbance due to neural regulation

1. Neurological pathologies that inhibit bladder impulses;
2. Diseases in which nerve cells and their membranes are destroyed;
3. The presence of formations in the brain or spinal cord;
4. Spinal cord injury of various etiologies;
5. Taking certain medications with these types of side effects;
6. Other temporary causes in the nervous system;
7. Strong emotional experiences, fear, fright, stress;
8. Alcohol intoxication and severe intoxication;
9. In bedridden patients with prolonged immobility;
10. Surgical intervention in the abdominal cavity or pelvic organs.

It is extremely important to distinguish ischuria from anuria, in which there is no fluid in the bladder, as a result of which the act of urination does not occur.

Acute ischuria

The patient feels pain and discomfort coming from the blocked urethra. There is a strong desire to empty the bladder, but this cannot be done. On palpation, the abdomen is very tense in its lower part, touches are acutely painful.

Chronic ischuria

There is no pain or urge to empty the bladder, but there are symptoms of discomfort for a long time, which greatly debilitates the patient. Urination is difficult, and the man has to strain his abdominal muscles.

In some cases, you even have to press the palm of your hand on the bottom of the peritoneum to facilitate the process of deurination. A stream of urine is released with weak pressure and is characterized by intermittency. In most cases, there is no feeling of complete emptying, which makes you want to go to the toilet again.

As soon as one of the listed symptoms appears in the patient, it is necessary to undergo additional examination and, at a minimum, consult a urologist. Self-treatment is prohibited, as it can cause complications and threaten life and health.

Diagnosis and treatment

Diagnosis of ischuria involves the use of ultrasound examination. The following types of examinations are also required:

• cystoscopy of the bladder;
• ghost x-ray examination with contrast agent;
• ultrasound examination of the prostate and bladder;
• general urine and blood tests;
• men over 40 years of age need to undergo a PSA test, this is a kind of marker that detects prostate adenoma in the initial stage.

First aid for symptoms

You need to take a no-shpa tablet and call an ambulance as soon as possible. While waiting for the arrival of specialists, you should try to facilitate the flow of urine.

All home remedies are aimed at relaxing the smooth muscles of the urethra, which will at least slightly help remove accumulated fluid.

1. You need to take a warm shower, directing the stream to the lower abdomen. It is important to prevent excessively hot water from entering;
2. In some cases, a cleansing enema may help;
3. The antispasmodic no-shpa can be taken either orally or in the form of a suppository, rectally.

Treatment of acute form

In the acute form of ischuria in men, treatment consists of preliminary catheterization, when a flexible catheter is inserted through the urethral canal and stagnant fluid is released through it. Only after the pressure in the organ is relieved can diagnostics begin to identify the cause of the disease.

In cases where installation of a catheter is impossible for some reason, a drainage system with a thinner tube is installed. As soon as the outflow of urine is restored, the causes of urine stagnation begin to be treated.

Treatment of the chronic form

In chronic ischuria, the cause of fluid retention in the body is first eliminated. If the obstacles were mechanical, they can be removed surgically or by examination with an endoscope.

In most cases, urinary dysfunction is associated with prostate adenoma, which can be treated not only surgically, but also with medication. The prescription of the treatment regimen is selected by the doctor based on the patient’s medical history and the severity of the disease.

Possible complications

The most common complication of chronic ischemia is cystitis. This is also often accompanied by pyelonephritis in various stages of progression.

With acute urinary retention, there is a danger of rupture of the bladder and excessive stretching of its walls. Against this background, acute renal failure may develop, since the fluid filtered by the kidneys does not find an outlet.

Prevention

In order to protect yourself from stagnation of urine, you need to monitor your health and visit a doctor regularly. There are also a number of general recommendations from doctors, compliance with which will improve the patient’s general condition.

Acute urinary retention occurs as a result of compression of the urinary tract (adenoma or prostate cancer, cicatricial stricture of the urethra, prostatitis) with a decrease in the contractility of the muscular wall of the bladder. In case of prostate adenoma of the I - II degree, acute urinary retention is facilitated by hyperemia of the pelvic organs (alcohol consumption, hypothermia, overwork, prolonged retention of urination, prolonged sitting or lying down), and less often - the prescription of diuretics. Any of these predisposing factors leads to overdistension of the bladder and loss of detrusor function.

Code according to the international classification of diseases ICD-10:

• R33- Urinary retention

Acute prostatitis often occurs at a young age. Untreated or poorly treated prostatitis is often accompanied by dysuric symptoms. In making a diagnosis, general symptoms of inflammation are important: fever, chills, pain in the perineum. When digitally examining the prostate gland, abscess formation is often determined. Acute delay urine is often the first symptom of scarring urethral stricture. A carefully collected anamnesis helps in diagnosis. Neurogenic bladder dysfunction can also be accompanied by an increase in residual urine up to acute retention. Neurogenic dysfunction results from spinal cord injury, pelvic surgery, general anesthesia, spinal anesthesia, and medications that affect the innervation of the bladder, proximal urethra, or external sphincter. In women, acute delay urine usually develops as a result of neurogenic and psychogenic factors or compression of the urethra by a cancerous tumor, scar stricture, etc.

Symptoms, course

Pain in the lower abdomen, urge to urinate. Upon palpation above the pubis, a pear-shaped, low-painful formation of dense elastic consistency is determined.

Urinary retention: Diagnosis

Diagnosis

clarified during catheterization of the bladder.

Urinary Retention: Treatment Methods

Treatment

Single or continuous catheterization of the bladder until its function is restored. After eliminating acute urinary retention, it is necessary to examine the patient and treat the underlying disease that led to its development.

Complications

catheterization: damage to the wall of the urethra, acute orchiepididymitis, urinary tract infection.

Forecast

depends on the underlying disease.

Diagnosis code according to ICD-10. R33

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Doctors usually diagnose people with partial or complete urinary retention. In the first case, the patient can go to the toilet on his own, but his bladder does not completely empty.

Complete retention involves the complete inability of a person to urinate on their own. This condition requires emergency and urgent medical care; it can be chronic and acute.

Acute urinary retention, ICD code 10(International Classification of Diseases) of which - R33, is characterized by a full bladder and the inability of a person to empty it independently. An acute form is a sudden manifestation of an illness that has not been observed before.

If it develops gradually, chronic delay is diagnosed. If an acute form of this condition is established, it is necessary to urgently call a doctor.

Causes

More often this disease is observed in men. The fair sex deals with such problems less often, because their urethra is somewhat shorter.

The most common causes of urinary retention are:

This phenomenon often occurs after a patient has undergone surgery on the genitals or rectum. In children, the most common cause of this phenomenon is phimosis. As you know, only boys get it.

Despite the fact that women do not suffer from such ailments as adenoma and prostatitis, problems associated with urinary retention also arise for them. In the fair sex, this often happens immediately after childbirth, or is caused by other factors:

• Tumor formations in the genital organs;
• Prolapse of the bladder.

Acute urinary retention in womenIt happens rarely, but also requires immediate treatment.

In older people, a similar condition is observed with cancer - in particular, the prostate gland in men.

If this problem is not addressed by a doctor, the overcrowded urinary tract or bladder may rupture. Urine will enter the abdominal cavity, causing acute unbearable pain. The next stage is the occurrence of severe acute peritonitis, which can be fatal.

Therefore, urinary retention is a dangerous condition not only for health, but also for life.

Symptoms

Urinary retention(ischuria; acute complete urinary retention) - accumulation of urine in the bladder due to insufficiency or inability to urinate independently.

ICD-10
R33 Urinary retention
N31 Neuromuscular dysfunction of the bladder, not elsewhere classified N31.1 Reflex bladder, not elsewhere classified
N31.2 Neurogenic bladder weakness, not elsewhere classified
N31.8 Other neuromuscular dysfunctions of the bladder
N31.9 Neuromuscular dysfunction of the bladder, unspecified
N32.0 Obstruction of the bladder neck
N32.9 Bladder lesion, unspecified
N33 Lesions of the bladder in diseases classified in other headings N39.9 Disorder of the urinary system, unspecified.

REASONS
Since women's urethra is much shorter than men's, urinary retention is extremely rare.
The reason most often is a mechanical obstruction to the passage of urine:
■ adenoma and prostate cancer;
■ acute prostatitis;
■ sclerosis of the bladder neck;
■ foreign body of the urethra;
■ urethral stone;
■ urethral rupture;
■ neoplasms of the bladder and urethra.
Urinary retention may be associated with a pathology of the central nervous system or be of a reflex nature:
■ tumors and injuries of the brain and spinal cord;
■ urinary retention in the postoperative period;
■ urinary retention during treatment for acute myocardial infarction;
■ neurogenic bladder dysfunction.

DIAGNOSTICS
HISTORY AND PHYSICAL EXAMINATION E
There are partial and complete urinary retention. With partial retention, urination occurs, but urine flows out in a thin stream or drops, and the bladder does not empty completely. Urinary incontinence with a full bladder is called paradoxical ischuria.
■ The patient is restless, as the clinic is determined by the sudden impossibility of emptying the bladder, accompanied by a painful, sharp and fruitless urge to urinate, and severe bursting pain in the lower abdomen. The pain can spread throughout the abdomen.
■ Since reflex intestinal paresis occurs, abdominal bloating appears, and symptoms of peritoneal irritation may occur.
■ Upon examination, a bulge is detected in the suprapubic region, which is especially visible to the eye in thin subjects. On percussion - dullness (a distinctive sign from intestinal bloating). An enlarged bladder is usually easily determined by palpation. Palpation is painful and increases the urge to urinate.

DIFFERENTIAL DIAGNOSTICS
■ First of all, the situation must be differentiated from anuria. Anamnesis matters. With anuria the following are observed:
✧ water and electrolyte disorders;
✧ smell of urine in exhaled air;
✧ lack of urge to urinate;
✧ bladder is empty.
■ Intestinal obstruction is manifested by repeated vomiting, bloating, and increasing dehydration. At a later stage, intestinal paresis and a picture of an acute abdomen develop.
■ Acute surgical pathology in the abdominal cavity is characterized by abdominal pain of a different nature. There is no urge to urinate. An objective examination reveals severe pain in some area of ​​the abdomen or throughout the entire abdomen, symptoms of peritoneal irritation. An enlarged bladder in the suprapubic region is not palpable.
■ The result of catheterization of the bladder has differential diagnostic significance: the evacuation of a large amount of urine and the rapid improvement in the patient’s condition indicate precisely acute urinary retention.

TREATMENT
TREATMENT MEASURES
Acute urinary retention is considered a urological emergency that requires emergency intervention.
Emergency bladder emptying is indicated. The intervention is carried out already at the prehospital stage. To do this, catheterization is performed with an elastic catheter (a metal catheter cannot be used) or suprapubic puncture of the bladder.
■ When catheterizing the bladder, asepsis must be observed. It is performed using sterile equipment. Catheterization in men requires some skill. It is carried out as follows:
The patient is in a supine position.
✧ The penis is grabbed with the fingers of one hand using a sterile bandage; holding it slightly stretched upward, expose the head, wipe it with a disinfectant solution on a sterile swab.
✧ It is advisable to introduce 10 ml of 1% lidocaine gel into the urethra; in the absence of a gel, use sterile petroleum jelly, which is applied to the catheter.
✧ The catheter is inserted with gentle pushes until it penetrates the bladder, as evidenced by the appearance of urine at the outlet (if an obstacle occurs at the last stage, before the catheter penetrates the bladder, you need to wait 1-2 minutes, pressing lightly on the catheter - the catheter itself will easily will go further).
✧ Urine is collected for possible research in a sterile container.
■ Because women's urethras are shorter than men's, it is easier to catheterize their bladder. The manipulation is performed in compliance with the same aseptic rules. The mouth of the urethra is found by spreading the labia minora as far as possible.
■ Contraindications for catheterization are inflammatory processes in the area of ​​the mouth of the urethra, urethritis, acute prostatitis, trauma to the urethra (history of trauma, bleeding from the urethra).
If catheterization is unsuccessful, a suprapubic puncture of the bladder can be performed, however, at the prehospital stage, attempting to puncture the bladder should only be done as a last resort, when delivery of the patient to the hospital will take a long time. Contraindications are acute cystitis, paracystitis, suspicion of a bladder tumor or a decrease in its capacity (tuberculosis, interstitial cystitis, etc.).
Technique for suprapubic bladder puncture:
■ the patient is in a supine position;
■ make sure that the formation palpated above the pubis is caused precisely by an overfilled bladder;
■ observe asepsis as much as possible (as when performing an operation: sterile mask, gloves, gown, cap);
■ infiltrate the skin 2–3 cm above the upper edge of the pubic symphysis along the midline with a 1% lidocaine solution, having previously treated it with an antiseptic (the hair directly in the place where the puncture will be performed can be cut off with scissors);
■ puncture is performed with a thick long needle (with a lumen of 1 mm; length 15–20 cm) with a syringe connected to it;
■ insert the needle strictly vertically, constantly tightening the syringe piston. During puncture, the needle encounters two dense layers - the skin and the aponeurosis of the external oblique muscles, after which it easily penetrates through the muscle layers of the anterior abdominal wall and the wall of the bladder. Penetration of the needle into the bladder causes urine to appear in the syringe. To drain urine, a sterile tube is placed on the needle;
■ remove the needle at the end of the manipulation.
After the intervention, hospitalization of the patient to the urology department is usually indicated for the purpose of additional examination and further treatment.

FORECAST
The prognosis for urinary retention depends solely on the disease that caused it. On the one hand, in some patients, a single urinary retention associated with stress or another psychological factor may never happen again. On the other hand, in the presence of organic pathology of the genitourinary organs or the central nervous system (in the case of functional urinary retention), the condition recurs.

Urinary retention is a painful phenomenon in which a person is unable to voluntarily empty a full bladder. Another name for this condition is ishuria. There are a large number of reasons that can cause a violation of the outflow from the organ. The doctor must conduct a full examination of the patient to find out the nature of the pathology and, based on this, prescribe the correct treatment.

Photo 1. Urinary retention is a serious disease with serious consequences. Source: Flickr (leslie)

Disease code according to ICD 10

According to the tenth revision of the International Classification of Diseases (ICD-10), the phenomenon of urinary retention has code R33. Refers to symptoms and signs associated with the urinary system. It is characterized by a full bladder when a person cannot empty it independently.

Types and forms of urinary retention

There are acute and chronic forms of the disease. The first option is considered an emergency in urology. This is due to the fact that in the absence of outflow from the bladder, kidney function is impaired. Within a few hours, complete suppression of their activity may occur with the development of intoxication.

If a patient has had difficulty urinating for a long period of time, he is diagnosed with chronic retention. This condition is less dangerous for the health and life of the patient, but can significantly reduce the quality of life. If measures are not taken to get rid of the cause of this phenomenon, it can become acute.

The chronic form is divided into complete and incomplete. Complete is characterized by the absolute impossibility of independent urination. In this case, the patient is given a catheter through which accumulated urine is removed.

Incomplete chronic ischuria is characterized by the presence after each act of urination. This pathology can progress and gradually become complete.

Separately, there is paradoxical ischuria, when a patient with a full bladder cannot spontaneously urinate, but a small amount of urine is released from the urethra. This is due to overstretching of smooth muscle fibers and disruption of nervous regulation.

Causes of pathology in men

Difficulty urinating in men, up to complete delay, may occur in the presence of mechanical obstacles and functional disorders which are associated with impaired tone of the muscle tissue of the urinary tract.

The first group of reasons include:

• urolithiasis when a stone enters the bladder and closes its outlet;
• phimosis, or narrowing of the foreskin, which compresses the head of the penis;
• pelvic hematomas and vascular lesions;
• inflammatory diseases of the genital organs– acute and chronic prostatitis plays an important role here;
• hyperplasia() prostate gland - as its size increases, compression of the urethra occurs, which leads to impaired outflow;
• genital injuries.

Functional disorders that can cause urinary retention:

• central nervous system diseases, spinal and brain tumors, myelitis, neurosyphilis;
• disturbance of the reflex associated with urination, after undergoing surgery on the pelvic organs, mental illness, poisoning, etc.

Pay attention! The most common cause of chronic and acute urinary retention in men is prostate adenoma. This disease occurs in most patients over 60 years of age. Therefore, urinary retention can be called a pathology of old age.

Symptoms and signs

Manifestations of pathology include:

• inability to urinate independently;
• the appearance of pain in the lower abdomen;
• with significant filling of the bladder - an increase in the size of the abdomen, the appearance of swelling above the pubis. When pressing on it, the pain may increase;
• constant strong desire to urinate.

At the same time, the patient may exhibit signs of another pathology that has caused a disturbance in the outflow of urine. For example, body temperature may be increased, blood clots may be present in the urethra, symptoms characteristic of trauma to the pelvis and abdomen.

Pay attention! If any of the above symptoms appear, you should immediately consult a doctor. Untimely medical assistance can lead to serious complications.

Possible complications

Acute urinary retention in itself is a complication of many diseases of the genitourinary system. However, she can lead to even more severe events, such as bladder rupture. As a result, the patient develops peritonitis - a serious condition associated with inflammation of the peritoneum due to urine entering it. In this case, the only way to help is surgically.

Diagnostics

Identification of this condition is based on the presence of characteristic symptoms. The problem is determining the cause of urinary retention. To do this, the doctor conducts X-ray examination, ultrasound of the abdominal cavity and pelvic organs, and also urethrography to determine if it is damaged.

At the same time, laboratory blood tests are performed to assess the general condition of the patient and the severity of inflammatory processes.

Methods for treating urinary retention

Since urinary retention is not an independent disease, first of all it is necessary to determine the cause that caused the outflow disturbance. Only after this can treatment begin; it may be necessary to involve not only urologists, but also doctors of other specialties.

To the patient a catheter is inserted into the urethra to remove accumulated urine through it. This will relieve the acute condition and move on to drug therapy. In some cases, for example when the urethra is significantly damaged, it is impossible to insert a catheter into it. Then spend cystostomy surgery, in which a hole is created in the wall of the bladder to drain its contents.

Drug therapy

For urinary retention, patients are prescribed taking antimicrobial and anti-inflammatory drugs. Among antibiotics preference is given to representatives of the sulfonamide group. The duration of treatment is determined by the attending physician based on the severity of the disease and the cause.

Pay attention! Medicines and folk remedies cannot lead to a complete cure of the patient, since they do not affect the cause. In many cases, it is necessary to perform an operation aimed at eliminating a mechanical obstruction to the outflow of urine.

Folk remedies

Such medications should be taken as an addition to primary therapy. They make it possible to reduce the severity of the manifestations of the disease, relieve pain and inflammation.

For this you can use alcohol tincture of tea rose fruits, rose hips, ground walnut shells. It will also be useful juniper bark decoction.

To prepare a tea rose infusion, take the fruits of this plant and pour alcohol or vodka over them. Leave for several days until the mixture turns straw-yellow. You should take 10 drops dissolved in water, 2 times a day.

An infusion of rose hips is prepared in a similar way. Leave to infuse for a week, shaking regularly. The readiness of the product can be determined by its light brown color. You should take 10 drops dissolved in water no more than three times a day.

Photo 2. Traditional medicine in this case does not deny the merits of traditional medicine.