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Urinary Retention Benign Prostatic Hypertrophy

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Urinary Retention Benign Prostatic Hypertrophy Powered By Docstoc
					                     Urine
                     Retention
                     By :
                          Anas Al-Bulayhi
                          Salem Al-Beshri
                          Sulaiman Al-Obaid

Supervisor : Dr.Mohhamad El-Sayed
Objectives:
   Anatomy of the bladder in general.

   Definition of urinary retention.

   Causes of urine retention.

   Signs and symptoms.

   Complication.

   Investigation.

   Treatment.
Anatomy of the Kidney
Anatomy




          Figure 26–18b
        Anatomy of the bladder:•
   Full bladder can
    contain 1 liter of
    urine.
   Location: it is
    situated behind the
    pubic bones.


   The Trigone is:
     openings of ureters.
     entrance to urethra.
 Blood       supply:
  Artreies:
        Superior and inferior vesical arteries. Branches
         the internal iliac arteries.
  Viens:
        Viens from the vesical venous plexus. It drains
         into the internal iliac vien.

 Lymph        drainage:
 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)
Embryology
   Kidney develops from intermediate
    mesoderm

   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
    chronic.

   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
    Straining
    A sense of incomplete voiding and urgency
    As the bladder remains full, it may lead to
     incontinence, nocturia (need to urinate at night)
    High frequency.
•Causes of urine retention:
   Obstructive of the urine way:
       Prostatic enlargement. (Benign prostatic hypertrophy)
       Bladder neck stenosis.
       Kidney Stones.
       Tumors. (Prostate cancer)
       Congenital urtheral valve abnormalities.
       Acute urethritis or prostatitis.
   Neurogenic:
       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
    hypertrophy.
   The cause of BPH is not well understood.
    No definite information on risk factors
    exists.
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:

   Pyelonephritis:
    Kidney and ureter infection usually bacterial from
    the bladder.
   Hydronephrosis:
    Dilation of the kidney with urine, caused by
    backward pressure on the kidney when
    the flow of urine is obstructed.
   Stones formation.
   Renal failure
Renal Failure :
   Is a situation in which the kidneys fail to
    function adequately.



   Divided into two categories : Acute and
    Chronic Renal Failure
Acute Renal Failure (ARF) :
 A rapidly progressive loss of renal
    function
Characterized by:
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
    electrolyte derangement.
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
causes :
 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:
      Urinary catheterization.
      Suprapubic cystostomy.

   Chronic urinary retention:
      Prostatectomy.
      Transurethral resection of the prostate. (TURP)


   Medications :
     alpha-adrenergic blockers (tamsulosin).
     antiandrogen > 5α-reductase inhibitors (finasteride)
Urine Retention Treatment: Cont.

Kidney Stones:
   Medications :
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
ESWL
   Kidney stones can sometimes be broken
    up by sound waves produced by a
    lithotriptor

   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.

				
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