Urinary retention is a urological emergency most common and can occur anytime and anywhere.
Means that a doctor or nurse wherever he served, or will likely ever encounter this disorder. Therefore, the question must be able to detect the disorder and can then start handling it correctly.
When urinary retention not handled properly, will result in complications that aggravate morbidity of patients concerned. Basically do not need special equipment or skills to detect and handle patients with urinary retention, anything that causes the disorder.
Problems that are often encountered :
- Urinary retention was not detected because it is unthinkable abnormality, the patient did not complain or say that can still pee on a regular basis (paradoxical incontinence).
- Retention add to the suffering or causing harmful complications, even be permanent and this can happen because the doctor or nurse to handle the disorder without regard to the specified requirements, inexperienced or does not have the required equipment.
In this paper, will be described in the fundamental causes of urinary retention, how to detect and correct way of handling and will be presented as well as some tips to keep in mind.
Urinary retention is a condition where the sufferer can not remove the accumulated urine in the bladder so that the maximum capacity of the bladder is exceeded.
Micturition process:
Bladder has a dual function
1. Accommodate urine as a "reservoir". In this phase, the bladder muscle (detrusor) in a state of relaxation while in a state of tense sphincter (closing). When urine volume reaches physiological capacity (in adults ranges between 250-400 ml), there will be a stimulus to micturition, but the process can still be suspended because of micturition retained by the concerned. When urine volume reaches maximum capacity (in adults ranges between 500-600 ml), increasing stimulation for micturition, causing discomfort and micturition process can still be put on hold while the urethral sphincter tense eksternum consciously (striped muscles).
2. Emptying the contents, called micturition process. This event requires cooperation harmoniously coordinated between detrusor contraction and sphincter relaxation so that the urine that had gushed out until the pot is empty.
In the second phase of the above, the drainage of the bladder to prevent urine back into the ureters (to prevent reflux).
Micturition process will run smoothly when the detrusor and sphincter in good condition, normal function (coordinated in harmony) and there are no obstacles in the urethra.
Cause of urinary retention.
- Detrusor weakness.
- injury / disorder in the spinal cord, nerve fiber damage (diabetes mellitus), detrusor experience stretching / dilation is excessive for a long time.
- Impaired coordination of detrusor-sphincter (dis-synergies)
- injury / spinal cord disorders in the cauda equina.
- Constraints on the way out the urine:
- urethral stricture
- abnormal prostate gland (BPH, Ca)
- urethral stones
- urethral damage (trauma)
- blood clot in the lumen of the bladder (clot retention) etc..
Result of urinary retention
- Bladder expands beyond the maximum capacity so that the pressure inside of the walls lumennya and voltage will increase.
- If this situation is allowed to continue, increased pressure within the lumen will obstruct the flow of urine from the kidney and ureter, causing hydroureter and hydronephrosis and renal failure occurs slowly.
- When the pressure within the bladder increases and exceeds the resistance in the urethra, the urine will radiate over and over again (in small amounts) by the patient uncontrollably, while the bladder remains full of urine. This situation is called: paradoxical incontinence or "overflow incontinence"
- Voltage of the bladder wall continued to rise until the limit of tolerance is reached and after this limit is passed, the bladder muscle will be dilated so that the capacity of the bladder exceeds the maximum capacity, with the force of contraction of the bladder muscles will shrink.
- Urinary retention is a predilection for the occurrence of urinary tract infection (UTI) and when this happens, it can lead to serious conditions such as acute pyelonephritis, urosepsis, particularly in elderly patients.
Management of Urinary Retention
When the diagnosis of urinary retention is enforced correctly, management determined based on issues related to the cause of retention of urine.
Catheterization
Conditions
- Performed by the principles of aseptic
- Use catheter Nelaton / type that is not too big, kind of Foley
- Sought no pains to avoid spasm of the sphincter.
- Cultivated with a closed system when the catheter remains.
- Given prophylactic antibiotics before insertion of a catheter (usually not needed antibiotics at all). Catheters were maintained as short as possible, just along still needed.
Catheterization technique
- Foley Catheter sterile, for adult size 16-18 F.
- Disinfection with desinfektans effective, does not irritate the skin of the genitalia (no alcohol)
- Topical anesthesia in patients who are sensitive to 2-4% xylocaine jelly. Jelly is at once acts as a lubricant. (On stone or urethral stricture, resistance will be felt when entering the jelly)
- Spread with jelly sterile catheter inserted into the urethra. In the female patient is usually no problem. In the male patients, a catheter is inserted gently until urine flows (always note the number and color / aspect urine), then the balloon was developed by 5-10 ml. .
- When it was decided to settle, the catheter is connected to a sterile reservoir bag and maintained as a closed system.
- Catheter in fixation with plaster on the skin proximal thigh or inguinal region and labored to lead kelateral penis, this is to prevent necrosis due to pressure on the ventral part of the urethra in the area penoskrotal.
