3. Anuria and Acute renal failure (ARF)
Definition
• no urine output or less than 200 ml/24 hours (while bladder
is empty).
Differential diagnosis:
Urinary retention (bladder is full)
Causes
• Pre renal (functional)
• Renal-intrinsic (structural)
• Post renal (obstruction)
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
7. Causes of Post-renal ARF
• Post renal obstruction due to
– Prostatic hypertrophy
– Blocked catheter
– Malignancy (obstructing both ureters):
Bladder cancer.
Prostatic cancer
Retroperitoneal tumors or pathology
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
15. Acute Urinary retention (AUR)
• Acute retention is characterized by an acute
onset of suprapubic discomfort associated
with the desire, but inability to urinate.
• It is typically seen in men, when the cause is
usually obstructive: for example, benign
prostatic hyperplasia, prostate cancer or
urethral stricture.
• It can occur in women, due to pelvic mass or
neurogenic bladder.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
16. Acute Urinary retention (AUR)
• AUR may be associated with previous LUTS:
obstructive and irritative.
• Typically, patients have increasing preceding
LUTS till reaches complete retention.
• Usually those patients have acute-on-chronic
retention.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
17. Acute Urinary retention (AUR)
• AUR can be precipitated by:
Medications e.g. anticholinergic or sympathomimetic
agents (cough and cold remedies).
Urinary infection.
Excessive fluid intake.
Consequences of surgery (postoperative pain, effects
of anesthesia or analgesia and loss of mobility).
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
18. AUR- Initial Management
• Urethral catheterization is straightforward and will relieve
the patient’s symptoms instantly.
• Suprapubic catheterization is used in patients with a
history of urethral stricture or previous traumatic
catheterisations,
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
19. AUR- Further management
Acute retention
A trial of catheter removal after alpha blocker is justified.
Acute –on-chronic retention (residual urine > 800cc)
• they should probably proceed to (TURP)
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
20. Clot retention
• Retention due to obstruction of urine
pathway by blood clots filling the
bladder.
• occur as a result of bleeding from a
renal or bladder tumor or,
commonly, following TURP.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
21. Clot retention- investigations
Lab
• measuring baseline haemoglobin, platelets
and blood clotting.
Radiology
• IVU is the traditional investigation for
hematuria.
• Pelvi-abdominal U/S for masses or prostatic
enlargment.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS
22. Clot retention- management
• Resuscitation by a wide bore IV line,
monitoring vital data and blood transfusion.
• Triple-way catheter (22 or 24 Ch) to
evacuate clot and irrigate the bladder
• Anticoagulant and antiplatelet drugs
should be stopped, if feasible.
• cystoscopy after the bleeding has
settled down and the catheter has been
removed, to identify and treat the cause.
By Younan Ramsees, MBBcH Revised by M.A.Wadood , MD, MRCS