The situation occurs more often in men in women is much rarer. To cope with it alone is impossible. Introduction of medicines antispasmodic action is ineffective. The greatest difficulty in diagnosis is paradoxical ischuria. It is manifested by overflow of the bladder and separate the drip dripping of urine. Residual urine creates a feeling of incomplete emptying.
Urinary retention or ischuria is not a disease. It is a syndrome caused by the inability of the urinary tract. The accumulation of urine in the bladder reaches a liter or more. Persons experiencing severe urgency, pain, but your own pee can’t.
What types of ischuria take into account doctors?
The types of ischuria vary in the clinic.
According to the preserved ability to urination are:
- complete ischuria patient even with the help of abdominal muscles and natureline can not excrete urine diversion is possible only with a catheter;
- incomplete – part of the outflow is available, but constantly remains a large residual urine volume (liter).
For the duration of the delay:
- acute – occurs in the background of the common urination, sudden seizure;
- chronic goes unnoticed for the patient, revealed only when the manifestation of symptoms of the complications caused by prolonged stagnation (cystitis, pyelonephritis).
For the totality of these manifestations are observed in practice the following variants of the clinical course. Acute complete ischuria – is characterized by the sudden development, the flow of urine stopped.
- on the paroxysmal acute pain over the pubis;
- strong urge to urinate.
During the inspection identify Velikobritanii protrusion in the lower abdomen, tenderness in the area of the bladder. The state should not be confused with anuria, in which the bladder no urine due to disrupted renal filtration function. Therefore, no painful urination.
Acute incomplete – is also growing fast, but urine small portions and complete emptying does not occur. Patients constantly have heaviness in the lower abdomen, periodically turning into severe pain. Chronic full – as a consequence of a long course of the disease is formed for a month or several years. Excretion of urine is done only by the catheter.
The most common cause of chronic ischuria men – prostate hyperplasia
Chronic incomplete – emptying is 20% of the required amount. Have remaining urine output catheter. The acute form often fall in the field of influence of urologists. Paroxysmal pain forcing patients to seek medical attention. Excretion of urine and subsequent diagnostics allow to find out the cause, apply the best method of treatment and prevent complications.
Unfortunately, in chronic forms the diagnosis turns out neglected, against the background of severe inflammation, renal disease, sepsis.
The causes and mechanism of occurrence
Factors driving Isuzu, very diverse.
Mechanical – in diseases, to compress the urinary tract or become a barrier to the flow of urine:
- prostate adenoma in men;
- blockage of the urethral canal by blood clots in injuries, hematuria;
- adhesions of the urethra;
- phimosis and paraphimosis;
- stones in the bladder neck.
Possible compression at the expense of neighboring organs (tumor growth, abscess) in children a violation of the outflow in connection with congenital anomalies.
Neurogenic – include diseases of the nervous system:
- brain tumors;
- consequences of stroke;
- traumatic lesion of the spinal cord.
Functional and reflex – this includes:
- postoperative complications in the form of innervation;
- emotional arousal;
- the consequences of childbirth for women;
- conditions associated with prolonged bed rest regime, an uncomfortable posture for urination;
- the toxic effects of sleeping pills, alcohol, drugs, compounds of atropine, groups of ganglionic;
- response to pain, shock;
- the effects of anesthesia;
- mental alterations (hysteria) with spastic contraction of the muscles of the urethra.
The main role in the mechanism of development of ischuria play:
- increased resistance to the flow of urine;
- the decrease in the contractility of the buoyancy bladder muscles (detrusor).
The resistance is growing against the background of mechanical outflow obstruction. An increase in pressure inside the bladder leads to hyperextension, subsequent degenerative changes and replacement of muscle fibers to the connective tissue.
Neurogenic disorders causing decreased tone of the detrusor during the activation of the sphincters of the bladder neck and urethra.
Paradoxical ischuria often formed with long-term chronic diseases. In this case a combination of loss of tone of the detrusor and sphincter of the urethra. Therefore, urine “passes” through the channel drops.
What are the diagnostic methods?
To confirm that the ischuria is necessary to clarify the patient or his relatives evolved as a pathology, are there any diseases of the urinary organs, ask about past injuries, diseases of the nervous system or mental disorders.
Bulging of the bladder is seen on examination of the abdomen
The upper boundary is above the fold. Palpable mild stress education. Because of the constant urgency patients are very restless, complaining of pain. It is necessary to help the patient and to withdraw the urine with a catheter. To prevent the growing spasm of the urethra before the procedure, administered spasmolytic action (Atropine, Platifillin). Rarely have to use the puncture and aspiration syringe.
The next step is finding the cause ischuria. To do this, the patient must undergo a complete examination from a urologist. Women obligatory consultation of the gynecological bimanual palpation of the uterus and appendages. Men examining through the rectum urologist and palpates prostate.
The list of studies:
- Urine analysis will reveal the inflammatory process and pathogens. If bacteriuria appoint a research method tank. sowing.
- Blood can indirectly judge about the activity of inflammation, biochemical tests for residual nitrogen, protein, electrolytes help to set the initial-stage renal disease.
- Cystoscopy is a method of review of the internal surface of the bladder. Urologist inspects the mouth of the ureters, the neck, the area of the triangle. They are most often localized polyps, tumors. If you suspect a malignant growth taking material for biopsy.
- Contrast the methods of research involve the introduction into a vein (intravenous) or into the bladder (retrograde) colorant that is visible on subsequent x-rays. Thus reveal developmental abnormalities, tumor growth, impaired function.
- Abdominal ultrasound helps to check the neighboring organs.
- TRUS – need a way to set the size of the prostate gland in men.
May need prolonged conservative treatment or surgery to eliminate the tumor, adenoma, congenital anomalies and other mechanical obstacles.
The stagnation of urine in the bladder extends above, dilate the ureters and pelvis
What are the possible complications?
The refusal of a patient from the survey is fraught with repetition of an attack of acute or delay transition to chronic.
The severe consequences of missing treatment may be:
- the development of chronic inflammatory diseases of the urinary organs (pyelonephritis, glomerulonephritis, cystitis) in connection with a high probability of infection of residual urine and reflux reflux in the upstream structure;
- a significant expansion of the renal pelvis (hydronephrosis) with compression of the parenchymal tissues of the kidney;
- accelerated formation of stones from the salt precipitate bouts of kidney stones, blood in the urine;
- the chronic kidney failure.
Isuzu can completely eliminate at an early stage. On the background of complications will need continuous treatment of chronic diseases, and urinary retention have to cope only with the catheterization or surgical method.