Helping a patient with acute urinary retention

There are two conditions characterized by lack of urination , this is an acute urinary retention and anuria. It is necessary to distinguish them from each other, because the causes and consequences of each of them are different, which means that the tactics of treatment are also different.

In acute urinary retention, the bladder is full, but urination is not possible due to an obstruction to urinary outflow through the urethra. With anuria, the bladder is empty, since urine is not produced by the kidneys or its entry into the bladder is disturbed due to some obstruction in the upper urinary tract. Acute retention of urine in childhood can be caused by a spasm of the sphincter of the bladder. In other cases, the child may delay urine due to severe pain during urination against the background of inflammatory processes in the urethra, the external genitalia. The causes of acute urinary retention may be the stone of the urethra, its trauma, infringement of the head of the penis with the flesh of the flesh in boys( phimosis), as well as the disease of the central nervous system. To exclude acute urinary retention, a catheterization of the bladder should be performed. In the case of anuria on a catheter inserted into the bladder, urine does not separate or appears in a small amount. Urgent care for acute urinary retention is the withdrawal of urine from the bladder through the catheter. In case of impossibility of catheterization, a temporary stoma is imposed on the overflowing bladder until the causes of urinary retention are eliminated.

Anuria, depending on the causes, is divided into arterial, prerenal, renal, postrenal and reflex.

Arenal anuria is rarely seen. It happens in patients with congenital absence( aplasia) of the kidneys. However, it should be noted that the absence of urine in patients within the first 24 hours is a normal phenomenon, and there is no need to worry. If urination is absent for more than 24 hours, then an urgent explanation of the reasons is required. The urine retention in the patient can be noted due to such developmental anomalies as congenital valves of the urethra, or in case of fusion in the area of ​​its external urethra.

Prerenal anuria occurs with insufficient blood supply to the kidneys or its cessation. This type includes anuria with severe heart failure and vascular pathology. Progressing heart failure is characterized by pronounced peripheral edema, fluid retention in the body cavities( ascites, hydrothorax).To vascular pathology, leading to the development of anuria, include thrombosis or embolism of the renal vessels, the inferior vena cava. Anuria can also occur when these vessels are compressed by a tumor, metastasis. To the disorder of the renal blood circulation result in heavy blood loss, shock. Decrease in systolic pressure below 50 mm Hg. Art.causes a violation of filtration in the kidneys.

Renal anuria is caused by pathological processes in the kidneys themselves. Discontinuation of urine as a result of the disease occurs in the late stages of chronic glomerulonephritis, chronic pyelonephritis, bilateral tuberculosis and with such congenital malformations as polycystosis. Sometimes a renal anuria also occurs with a rapidly progressive acute glomerulonephritis. The causes of acute renal anuria can be poisoning with poisons and medications( sulemoma, pachycarpin, acetic acid, etc.), transfusion of incompatible blood, extensive burns.massive injuries with a crushing of the muscles. Rarely anural anuria occurs after extensive surgical interventions as a result of absorption of tissue degradation products, as well as after administration of sulfanilamide preparations( with restriction of fluid intake) due to clogging and damage of the renal tubules by crystals of sulfonamides.

Postural anuria occurs if there is an obstruction to urinary outflow from the kidneys. The most common cause of it are stones localized in the upper urinary tract. In addition, postrenal anuria can be the result of compression of the ureters by a tumor, scars or inflammatory infiltrate in the cell of the pelvic cavity.

Reflex anuria can be the result of the inhibitory effect of the central nervous system on urination as a result of the action of various strong stimuli( with sudden intense supercooling, violent instrumental interventions on the urinary tract), and also after the triggering of the renal reflex( cessation of the kidney after blockage by the ureteral lumen of another kidney).Symptomatically, anuria manifests by stopping urge to urinate. After 1-3 days of the absence of urine, the symptoms of renal failure develop: dry mouth, thirst, nausea, vomiting, headache, skin itching. In the body, there is an accumulation of exchange and nitrogenous slags - the products of the decomposition of proteins, potassium, chlorides, nonvolatile organic acids. The blood reaction shifts to the acidic side( acidosis).Violated water-salt metabolism. Increase of these symptoms leads to the development of weakness, drowsiness, increased vomiting, the appearance of diarrhea, edema, dyspnea. Consciousness can be confused, a smell of ammonia is felt from the patient's mouth. Serum levels of urea and creatinine are very high in serum.

The nature of the treatment depends on the shape of the anuria. In patients with prerenal anuria, urgent medical assistance measures help maintain the cardiovascular system. In case of shock, it is necessary to restore the normal level of arterial pressure as soon as possible. With a large loss of blood, urgent compensation is required and the use of funds that stabilize the vascular tone. At the phenomena of vascular insufficiency( fainting, collapse) caffeine is injected subcutaneously, 40% glucose solution intravenously, put the warmers at the feet. Patients who are in serious condition are hospitalized for further treatment in the intensive care unit and intensive care unit. With renal anuria caused by poisons poisoning, acute renal failure due to kidney disease, urgent hospitalization in the hospital is required, where there is an apparatus for peritoneal dialysis or hemodialysis. With postural anuria, the main type of treatment is operative, so the patient is hospitalized in the urological or surgical department, where it is possible to conduct an emergency examination and eliminate the cause that caused the outflow of urine.

Foreign bodies of the bladder and urethra are rare. Symptoms of the foreign body of the bladder are pain in the lower abdomen, radiating into the external genitalia, frequent painful urination, the discharge of blood and pus in the urine. All these symptoms are aggravated by movement. There may be intermittent urine flow, and sometimes acute urinary retention develops. The diagnosis is confirmed with the help of ultrasound, X-ray examination or instrumental examination of the bladder( cystoscopy).When a foreign body enters the lumen of the urethra, pain occurs, which becomes stronger with urination. Urination is difficult, painful, there may be an acute retention of urine. The development of a purulent process in the urethra can lead to bleeding. Foreign body from it can not be removed on an outpatient basis, since the channel is easily damaged. The patient is injected with antibacterial and pain medications, and then hospitalized in a hospital to provide urgent specialized care.