ISHURIA

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ISHURIA (urine retention) - impossibility of emptying the bladder, in spite of urine overflow. If urine retention occurs suddenly, it is called acute; If it develops gradually as a result of the growing, long-lasting obstacle, the outflow of urine, it is called chronic.

Delayed urination may occur as a result of the following factors:

1) mechanical causes (adenoma, abscess or prostate cancer, acute prostatitis , urethral trauma, bladder stone or urethra, urethral tumor or bladder neck, phimosis);

2) CNS diseases (swelling and trauma of the brain or spinal cord, spinal cord, myelitis);

3) reflex functional reasons (after surgery on the perineum, rectum, female genitalia, after childbirth, under stress, alcohol intoxication, hysteria, involuntary long stay of the patient in bed, etc.);

4) drug intoxication (hypnotics, narcotic analgesics).

The most common cause of acute urinary retention is prostate adenoma , which is often found in men over 60 years of age. Naturally, acute urinary retention is predominantly a pathology of older men. Retention of urine in the presence of adenoma is promoted by causes that cause a rush of blood to her (long stay in sitting position, constipation, diarrhea, cooling, alcohol intake). In the history of frequent urination (especially at night), difficulty in starting urination, sluggish urine stream. With acute prostatitis, acute urinary retention develops against a background of fever, pain syndrome, terminal hematuria.

Less acute urinary retention occurs with injuries of the urethra, fractures of the pelvic bones; It is also observed predominantly in men.

A peculiar form of urine retention is the sudden "interruption" of the urine stream, which is usually a symptom of bladder stones. With the beginning of urination, the moving stone "closes" the inner opening of the urethra, and urination is interrupted. The patient has to change the situation so that it resumes. Some patients with bladder stones can urinate only in a certain position (squatting, sitting on their side, sitting). The delay of urination is combined with pain syndrome, hematuria.

Acute urinary retention can be one of the manifestations of diseases or damage to the brain or spinal cord with a disorder of the nervous regulation of detrusor and sphincters of the bladder (spinal cord, myelitis, spinal fractures with spinal cord compression or hemorrhage into it); With diseases of the central nervous system in ishuria there is no pain.

Acute retention of urine can have a reflex character: in the first days after surgical interventions on the abdominal organs, surgeries for abdominal hernias, hemorrhoids, etc. Sometimes it occurs in perfectly healthy subjects after taking large amounts of alcohol: it is caused by atony of the vesicle muscle . In elderly people, atony of the urinary bladder with the development of a delay in urine can be a consequence of treatment with atropine drugs.

The delay of urine can be complete and incomplete. At full delay the patient, despite a sharp urge to urinate and severe straining, can not allocate a single drop of urine; Such patients are sometimes given a urine catheter. With incomplete, partial delay, urination is performed, but after it a part of urine remains in the bladder (residual urine), its amount sometimes reaches 1 liter. If the amount of residual urine exceeds 100 ml, it can be determined percussion. Chronic incomplete ishuria can go unnoticed for the patient and can only be detected if complications develop, leading to urinary stagnation in the urinary tract and impaired renal function.

With prolonged retention of urine, not only the ultimate stretching of the muscular wall of the bladder occurs, but its atony with sphincter stretching, and urine from the overflowing bladder involuntarily drops out to the outside. This condition is called paradoxical ishuria. Often accompanied by instructions of patients that they constantly urinate in small portions, lead to the fact that acute urine retention in the presence of paradoxical ishuria is not recognized in time.

The diagnosis is based on anamnesis and objective research. The expressed painful syndrome causes the extremely restless behavior of the patient. When viewed in the suprapubic region, a swelling due to an overflowing bladder is revealed. Percussively, the upper limit of the bladder is determined, which, in acute urinary retention, can be located in the middle of the distance between the umbilicus and the pubic articulation; The bottom of the filled bladder often succeeds in palpating.

Complete urinary retention should not be confused with anuria, in which urine production ceases. With her, urination is also impossible, but there is no urge, the bladder is empty.

Treatment . Acute retention of urine causes severe pain and requires emergency care. Catheterization of the bladder in the presence of prostatic adenoma should be done only with a rubber catheter. After treatment of the external opening of the urethra with an antiseptic solution, the catheter, moistened with glycerine or vaseline oil, is injected into the urethra by tweezers. Progressive movement is made "short steps" of 2 cm. Do not force a catheter into the urethra, because with urolithiasis and acute prostatitis, bladder catheterization can lead to complications. If necessary, the catheter can be left for several days in the bladder (a permanent catheter), but in this case, in order to avoid attachment of the infection, the bladder is washed with a solution of antiseptics, antibiotics, furadonin , nitroxoline , etc. are prescribed. If a rubber catheter is not possible, the patient should immediately be directed to Urologist.

In the case of reflex urinary retention (for example, with postpartum, postoperative ishuria), you can try to urinate by irrigation of the external genitalia with warm water, by pouring water from one vessel to another (the sound of a falling stream of water can reflex urinate), insertion into the urethra 5 -10 ml of 1-2% solution of novocaine; If the above methods are ineffective and there are no contraindications, 1 ml of a 1% solution of pilocarpine or 1 ml of 0.05% solution of proserin is injected subcutaneously; If there is no result, the bladder catheterization is indicated.

In some cases, acute urinary retention often recurs. The main danger of re-catheterization in this case is the inevitable infection of the urinary tract until the development of urosepsis. After providing emergency assistance to patients with acute urinary retention, it is necessary to send to the urologist for examination, after which the question of the possibility and expediency of surgical treatment aimed at removing the obstruction to bladder emptying can be resolved.