Urinary Retention in Adult Males
Among many difficulties that you have to tackle as you are getting older, urinary retention in adult males remains as one of the commonest. Causes for urinary retention vary from urinary stones to even bladder cancers.
It is defined as the inability to completely or partially empty the bladder. However, it is traditionally classified as Acute and chronic urinary retention. Acute retention has a rapid onset associated with lower abdominal pain and absolute loss of urine output. Conversely, chronic urinary retention, which is more prevalent among adults, has an insidious onset where the patient progressively develops urinary symptoms. Those people usually pass only small amount of urine with sensation of incomplete bladder emptying.
Common symptoms of urinary retention (Lower urinary symptoms) are,
- Hesitancy – Difficulty in starting urination
- Intermittent urine flow
- Poor flow of urine despite having adequate water intake
- Straining to start and maintain urine flow
- Dribbling of urine at the end of urination
- Sensation of incomplete bladder emptying
Causes of Urinary Retention
Causes of urinary retention can be classified as obstructive and non-obstructive causes. In obstructive causes an obstruction at the level of bladder or at the level of urethra interrupts the passage of urine. It may be a urinary stone, a urethral stricture (narrowing) or prostatic enlargement in adults. Those people with obstructive urinary retention tend to develop overflow incontinence where high pressure inside the bladder overrides the urinary retention causing uncontrolled urine flow.
Non-obstructive urinary retention
It usually occurs due to weakness of the bladder muscles (detrusor muscle). Most commonly it’s caused by spinal code or peripheral nerve damage following accidents. In such instances, bladder is called as a neurogenic bladder. Treatments of neurogenic bladder is not very affective; thus most are managed with catheterization. Surgeries can be done to increase the bladder volume where part of the large intestine is removed and connected to the bladder wall.
Out of the obstructive causes of urinary retention,
beign prostatic enlargement(BPH) predominates in adult males. Prostate gland encircles the upper urethra where it originates from the bladder. Enlargement of this gland cause narrowing of urethra and subsequent urinary retention. Enlargement of prostate is natural and occurs as a part of the aging process. As long as the person doesn’t have any symptoms, a size less thsn 40 cc of prostate is considered as normal. About 50% of men develop BPH by the age of 60 years, 90% by 85 years. BPH may results in blood in urine in addition to the above urinary symptoms.
Complications of urinary retention includes
- Bed wetting
- Bladder stones
- Frequent urinary tract infection
- Dilatation of upper urinary tract including the kidneys
- Acute or chronic renal failure
Management of BPH depend on the symptoms of the patient and the prostate size. As long as the patient is asymptomatic and has no complications, doesn’t need of any interventions. Usually size of the intra-urethral part of prostate correlates with the urinary symptoms. This explains why some people are having very large prostates with no lower urinary symptoms and vice versa.
On the other hand, complications are more common in people with long standing obstructive urinary retention. In such people bladder contraction pushes urine in to the kidneys causing renal damage. On the other hand, obstruction (Or non-functioning bladder) causes urine accumulation inside the bladder which act as a perfect medium for bacterial growth. Therefore, those people tend to develop repeated urinary tract infections. The infections may ascend up to the kidneys causing pyelonephritis (kidney infection) and renal scarring. Ultimately these effects lead to renal failure.
Urinary Retention Therapy
Patients whom are having mild lower urinary symptoms are initially managed with medical therapy. It’s targeted on dilating the urethra and on reducing Dihydrotestosterone level which is a growth factor for the prostate. Surgical treatment is indicated if the patient is having large prostate (Usually above 60 cc) or severe lower urinary tract symptoms or if the patient fails to respond to medical therapy. The gold standard surgical management of BPH is Transurethral resection of prostate (TURP) where resection of the intra-urethral part of the prostate is done by a transurethral approach. However, it’s not advisable to do if the prostate is very large (80 cc) or if the resection time is expected to go beyond 1 hour. In such cases potentially life threatening condition known as TURP syndrome can occur.
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