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Urinary retention (Ischuria) :the inability to empty the full bladder

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Urinary retention, or ischuria (the term “urinary retention” is also used) is the inability to empty the full bladder. Ischuria can be expressed in varying degrees; there is both acute development and chronic difficulties with emptying the bladder, and almost always urinary retention is the result of a more general pathology, and not an isolated problem. However, ischuria in any case is a very serious symptom, fraught with the most serious consequences for the body as a whole. In particular, acute urinary retention is one of the leading causes of hospitalization and treatment under the emergency medical protocol.

In epidemiological terms, this condition does not reveal any significant trends, with the exception of age: if among patients of childhood, young and mature age, ischuria in males and females occurs with approximately equal frequency, then starting from old age (55-60 years) such samples are dominated by men: this statistical category is extremely prone to hyperplasia and tumors of the prostate, as a result of which the function of urination also suffers.

The reasons

The factors for the development of ischuria are very numerous and varied, therefore they are usually divided into two (three, four, etc.) large groups.

The most common cause is considered to be mechanical obstruction (obstruction) of the urinary tract, i.e. their blockage, blockade of the lumen. In turn, this can happen for many reasons: a migrating stone with nephrolithiasis , a tumor (three-quarters of cases of ischuria in elderly and senile men are due to malignant neoplasia or benign prostatic hyperplasia , through which the urethra passes), an abscess or severe swelling with acute inflammatory process, polyposis, pathology of the walls of the urinary tract, urethral stricture, a foreign body in the urethra or ureter, external pressure from neoplasms of the large intestine or, in women, tumors of the uterus. Mechanical causes also include injuries with tearing or crushing of the urinary tract (for example, with fractures of the pelvic bones), as well as rare cases of severe phimosis in boys, when the external opening of the urethra is completely blocked.

As a separate and extreme variant of ischuria, anuria is considered – the complete absence of urine due to functional failure of the kidneys.

Causes not related to the organic pathology of the genitourinary system include some neuroendocrine diseases; lesions of the central nervous system (traumatic, tumor, inflammatory); taking medications (sedatives, narcotic analgesics, atropine preparations, etc.); atony of the bladder due to heavy alcohol consumption; reflex ischuria immediately after abdominal operations, epidural or spinal anesthesia, childbirth. There is also psychogenic ischuria in the mentally ill (in particular, with hysterical neurosis) or in mentally healthy individuals with severe emotional upheavals.

Symptoms

There are acute and chronic ischuria, each of which can be complete (emptying the bladder is basically impossible without external intervention) or partial, when a certain amount of urine is excreted naturally (usually in small portions with frequent urges), and the other part, the larger one, remains in the urinary tract. bubble. Chronic ischuria develops most often against the background of tumor processes or strictures, neuroendocrine pathology; it is rarely complete, but in some cases the bladder has to be emptied through a catheter for years.
The clinical picture depends on the causes of urinary retention. In particular, acute ischuria can occur directly in the process of urination (for example, with a sudden obstruction of the lumen by a migrating calculus, blood clot, or foreign body). In other cases, there is a pain syndrome of one or another intensity (up to unbearable renal colic), a feeling of fullness, heaviness, fullness, painful urge to urinate, etc. Sometimes a small amount of urine is excreted by strong tension of the abdominal muscles or mechanical pressure on the lower abdomen.

As shown above, any urinary retention (acute and chronic, complete or incomplete) requires urgent medical attention: the likelihood of developing purulent forms of pyelonephritis and general urosepsis, renal failure, uremia (intoxication with protein breakdown products) and kidney death is too high. In general, ischuria, especially with delayed intervention or its complete absence, is a high-risk condition in terms of mortality.

 

Diagnostics

By itself, urinary retention is quite obvious to the patient (or his relatives, if the problem is dissimulated by the patient) and does not create diagnostic difficulties. In most cases, during examination, a spherical bloating in the projection of the bladder is observed and palpated. Instrumental research methods are used to identify the immediate causes of ischuria: X-ray studies can be prescribed (as a rule, this is contrast retrograde cystourethrography), ultrasound, cystoscopy, MRI, etc. In some cases, it is necessary to consult a specialist in psycho-neurological or neurosurgical profile.

With anuria (see above), the absence of urination is paradoxically combined with the absence of urge and a small degree of bladder filling.

Treatment

A measure of paramount importance and urgency is the removal of urine from the body. As a rule, catheterization is sufficient for this, but in some cases it is necessary to resort to surgical cystostomy (creation of an artificial urinary tract through the abdominal wall); occasionally, with psychogenic or neurogenic ischuria, it is possible to restore urination with the help of psychotherapeutic techniques, physiotherapy procedures or medical sedation.

The next, no less mandatory step is a thorough examination, if the causes of ischuria have not been previously established, and the treatment of the underlying disease, i.e. elimination of the diagnosed causes to the extent possible.

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