A urinary retention (Syn: urinary retention , ancient Greek ισχουρια ischouria ischuria ) occurs when the filled bladder can not be emptied spontaneously. Urinary retention can be extremely painful, but doesn't have to cause pain - especially if you have diabetes at the same time . If the pressure in the bladder rises so much that it overcomes the causal obstacle, there is an unregulated urine leakage in the sense of an overflow bladder .
Mechanical causes may jammed stones or foreign objects into the urethra , prostate enlargement , injuries or tumors of the bladder neck or urethra , urethral valves , -missbildungen or -verengungen, Meatusstenosen , phimosis or Paraphimosen be; But there are also neurogenic (nervous-related) and psychogenic (mentally-related) bladder emptying disorders.
If there is urinary retention, no urine flows because the drainage is obstructed. In anuria , no (or little) urine flows because no (or very little) urine is produced. These two conditions must be differentiated from a differential diagnosis. In the further course of time, urine flows again when urinary retention occurs. Even with anuria, residual urine can still empty from the bladder over time.
Acute urinary retention
The classic cause of acute urinary retention is benign prostate enlargement . The urethra can also be distal, e.g. B. clogged by stones, by an injury ( urethral stricture ) or tumors or severely narrowed. In the case of a herniated disc or multiple sclerosis (MS), acute urinary retention can occur due to damage to the nervous system. The disorder often manifests itself as a painful need to urinate without emptying the bladder. Since urinary retention can result in kidney damage if urine is retained for a long time, immediate medical treatment is necessary.
Chronic urinary retention
If there is chronic urinary retention, the urine often backs up into the kidneys, where it leads to pressure-related damage. Typical findings include hydroureters , hydronephrosis and an increase in urinary substances. Therapeutically, it is first carried out with a urethral catheter or a suprapubic catheter . If there is pressure damage to the tubular kidney function, a polyuric phase often occurs after the discharge with urine excretion of up to 6 liters per day.
If there is a neurogenic cause of urinary retention, the stretching pain is often only slight and causes few symptoms. The prolonged overstretching results in myogenic damage with residual urine formation, chronic urinary retention and the later resulting overflow incontinence .
Postoperative urinary retention
After spinal or epidural anesthesia , as is done in operations or caesarean sections , urinary retention can also occur, which can last for several hours. This form of urinary retention usually disappears by itself without therapeutic intervention. Early mobilization of the patient is helpful. Sterile single-use catheterization may have to be performed.
Urinary retention from medication
The administration of anticholinergics in the treatment of urinary incontinence can, in the most negative case, induce urinary retention, which can easily be remedied by reducing the dose. In some cases, in the case of urinary incontinence, artificially induced urinary retention is even desired in order to restore the continence to the patient for a certain period of time. In these cases, however, the urine must be drained through regular catheterization of the urinary bladder. Other drugs such as B. 1,4- benzodiazepine derivatives ( diazepam ) or antidepressants can cause urinary retention as a side effect .
Mentally caused urinary retention
Under certain circumstances, some people may not be able to empty their bladder even though the bladder is filled enough and has an urge to urinate. This problem of the "shy bladder" paruresis occurs only in certain situations that are perceived as annoying for these people, such as the presence of other people in public toilets, under time pressure on excursions, trips, ... or when means of transport are in motion, etc. This type of urinary retention affects more men than women of any age. The main causes seem to be excessive suppression of the natural urination reflex by the brain and relaxation of the bladder muscles due to stress.
Since acute retention of urine can lead to kidney damage due to the backlog of urine, immediate medical treatment is necessary. As an immediate measure, a urethral urinary catheter is usually placed. If a catheter cannot be inserted transurethrally or if an inflammatory process or urethral injury is suspected, a suprapubic urinary diversion is necessary. The cause of the urinary retention should also be clarified.
For residual urine quantities over 600 ml, fractional drainage of the urine is necessary in order to avoid bleeding of the bladder mucosa due to relative negative pressure. The indwelling catheter remains in place for 1–3 days for permanent drainage, after which a catheter discharge attempt and residual urine control is carried out. If urine retention occurs again or if the residual urine volume is significantly higher than 100 ml, a further indwelling catheter or a suprapubic urinary drainage takes place.
Urinary retention in children can possibly be eliminated by placing the child in a bathtub filled with warm water. If this attempt does not result in spontaneous micturition , the urinary bladder must be emptied using a urinary catheter suitable for the child's anatomy (6-9 Ch. Disposable catheter ).
The treatment of mentally induced urinary retention is cognitive behavioral therapy , the aim of which is to reorganize fear-inducing and confusing thoughts and to practice overcoming situations that have been avoided. Since there is still no usable drug treatment available, patients with this bladder emptying disorder can be relieved of their "physical" complaints by intermittent self-catheterization of the urinary bladder.
In the film Der Schüler Gerber , a recalcitrant student claims his teacher's refusal to let him go to the toilet (for the actual purpose of disrupting the classroom): “ Tycho de Brahe died of urinary retention.” The teacher replies: “Nobody's ever on In fact, in Brahe's medical history before his death there was the suspicion of a rupture of the bladder after excessive ignoring of the natural urge to urinate for social reasons - a culturally and not medically induced urinary retention.
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