Supervisor : Dr.Mohhamad El-Sayed
Anatomy of the bladder in general.
Definition of urinary retention.
Causes of urine retention.
Signs and symptoms.
Anatomy of the Kidney
Anatomy of the bladder:•
Full bladder can
contain 1 liter of
Location: it is
situated behind the
The Trigone is:
openings of ureters.
entrance to urethra.
Superior and inferior vesical arteries. Branches
the internal iliac arteries.
Viens from the vesical venous plexus. It drains
into the internal iliac vien.
It drains into the internal and external iliac nodes.
Nerve supply of the bladder :
Sympathetic : Hypogastric Nerves (T11-L2)
Parasympathetic : Pelvic Nerves (S2,3,4)
Kidney develops from intermediate
The kidney goes under three steps :
Pronephros 3rd Week
Mesonephros 4th Week
Metanephros 12th Week
•Urine retention (ischuria):
Is incomplete emptying of the bladder or
cessation of urination; it may be acute or
Oliguria: defined as the excretion of less than
300 mL of urine per day
Anuria: no urine
Polyuria: is a persistent, large increase in urine
output, usually associated with nocturia.
Signs and Symptoms:
Poor urinary stream
A sense of incomplete voiding and urgency
As the bladder remains full, it may lead to
incontinence, nocturia (need to urinate at night)
•Causes of urine retention:
Obstructive of the urine way:
Prostatic enlargement. (Benign prostatic hypertrophy)
Bladder neck stenosis.
Tumors. (Prostate cancer)
Congenital urtheral valve abnormalities.
Acute urethritis or prostatitis.
Spinal cord injuries.
Anesthetiation after operations.
Benign Enlargement Of prostate
It is common for the prostate gland to
become enlarged as a man ages. This
condition is called benign prostatic
hyperplasia (BPH), or benign prostatic
The cause of BPH is not well understood.
No definite information on risk factors
Types of Renal Stones :
1- Calcium Stones:
The most cause of Calcium Stones is hypercalciuria,
Calcium Stones are composed of Calcium oxalate
and Calcium phosphate
2- Uric Acid Stones:
If the acid level in the urine is high or too much acid is
excreted, the uric acid may not dissolve and uric acid
stones may form.
Gout often develops these stones.
3- Struvite Stones:
Associated with the presence of urea-splitting bacteria,
most commonly Proteus.
These organisms are capable of splitting urea into
ammonia, decreasing the acidity of the urine and
resulting in favorable conditions for the formation of
Struvite stones. Struvite stones are always associated
with urinary tract infections.
4- Cystine Stones:
Associated with people suffering from cystinuria, who
accumulate cystine in their urine.
Complications of urine retention:
Kidney and ureter infection usually bacterial from
Dilation of the kidney with urine, caused by
backward pressure on the kidney when
the flow of urine is obstructed.
Renal Failure :
Is a situation in which the kidneys fail to
Divided into two categories : Acute and
Chronic Renal Failure
Acute Renal Failure (ARF) :
A rapidly progressive loss of renal
1- Oliguria (decreased urine production
less than 300 mL per day in adults
less than 0.5 mL/kg/h in children )
2- Body water and body fluids disturbances
Chronic Renal Failure: (Uremia)
Can either develop slowly and show few initial
symptoms. There are many causes of CRF. The
most common cause is diabetes mellitus.
Stage 1 CRF is mildly diminished renal function,
with few overt symptoms.
Stage 5 CRF is a severe illness and requires
some form of renal replacement therapy
Investigation of urin retention
Rectal examination may reveal enlargement
or nodularity of the prostate.
Prostate specific antigen (PSA) Test.
Blood test For BUN and serum creatinine.
Microscopic study of urine, which may show
proteins, red blood cells, pus cells, bacteria,
cellular casts and crystals.
X-Ray (Kidney stones)
CT-Scan (Kidney stones)
•Urine Retention Treatment:
Treatment depends on the underlining cause.
Benign Prostatic Hyperplasia
Acute urinary retention:
Chronic urinary retention:
Transurethral resection of the prostate. (TURP)
alpha-adrenergic blockers (tamsulosin).
antiandrogen > 5α-reductase inhibitors (finasteride)
Urine Retention Treatment: Cont.
1. alpha adrenergic blocking agent (Flomax). (which acts to reduce
the muscle tone of the ureter and facilitate stone passage. )
2. Spasmolytic (Atropine)
3. NSAID for relieving pain. (Aspirin)
Urologic interventions :
1. Extracorporeal Shock Wave Lithotripsy or (ESWL)
2. Open surgery
Kidney stones can sometimes be broken
up by sound waves produced by a
After an ultrasound device or fluoroscope
is used to locate the stone, the lithotriptor
is placed against the back, and the sound
waves are focused on the stone, shattering
it. Then the person drinks fluids to flush the
stone fragments out of the kidney, to be
eliminated in the urine.