URINE

RETENTION
Resky Alfiansyah A

Supervisor Pembimbing
Dr. Khoirul Kholis, Sp.U(K)
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Anatomy of Urinary Tract

- Kidney
- Ureter
- Blader
- Urethra
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Anatomy of Urinary Tract (KIDNEY)

Posterior View Selubung Ginjal

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Anatomy of Urinary Tract (KIDNEY)

Posterior View Selubung Ginjal

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Anatomy of Urinary Tract (Ureter)
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Anatomy of Urinary Tract (Blader)
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Anatomy of Urinary Tract (Urethra)

MALE FEMALE
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PHYSIOLOGY OF MICTURITION
 Definition

Urinary Retention can be defined as the

partial or total spontaneous inability of
the bladder to empty the urine produced
by the kidneys.

Urinary retention is not a disease, but a

condition that may be related to other
health problems, such as prostate
problems in men or a cystocele in
women.

National Kidney and Urologic Diseases Information Clearinghouse. Urinary Retention National Kidney and Urologic Diseases Information Clearinghouse. Natl Kidney Urol Dis Inf Clear house. 2016;
Meska MHG, Mazzo A, Jorge BM, de Souza-Junior VD, Negri EC, Chayamiti EMPC. Urinary retention: Implications of low-fidelity simulation training on the self-confidence of nurses. Rev da Esc Enferm.
2016;50(5):831–7.
 Etiology of Urine Retention

Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician. 2018 Oct
15;98(8):496-503. PMID: 30277739.
 Etiology of Urine Retention

Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician. 2018 Oct
15;98(8):496-503. PMID: 30277739.
 Etiology of Urine Retention

Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician. 2018 Oct
15;98(8):496-503. PMID: 30277739.
 Pathophysiology of Urine Retention
Obstruction
Obstruction causes urinary retention by
blocking the normal urine flow out of the
body

BPH causes bladder neck obstruction

through two mechanisms: prostate
enlargement and constriction of the
prostatic urethra from excessive
alpha-adrenergic tone in the stromal
portion of the gland.

National Kidney and Urologic Diseases Information Clearinghouse. Urinary Retention National Kidney and Urologic
Diseases Information Clearinghouse. Natl Kidney Urol Dis Inf Clear house. 2016;
Kowalik U, Plante MK. Urinary Retention in Surgical Patients. Surg Clin North Am [Internet]. 2016;96(3):453–67.
Available from: http://dx.doi.org/10.1016/j.suc.2016.02.004
 Pathophysiology of Urine Retention
Infection and Inflammation
Inflammation of the urinary tract at any level can cause narrowing and
obstructive urinary retention.
● Acute prostatitis → gram negative bacteria → swelling of the gland
● Urethritis → urethral edema
● Genital herpes → Inflammatino and sacral nerve involvement
● Vuvovaginitis

Dougherty JM, Aeddula NR. Male Urinary Retention. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK538499/
Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med. 2022;12(6).
 Pathophysiology of Urine Retention
Medication
TCA → decrease bladder detrusor
muscle contraction.

Sympathomimetics → increase
alpha adrenergic tone in prostate
and internal sphincter

NSAID → inhibits
prostaglandin-mediated detrusor
muscle contraction

Dougherty JM, Aeddula NR. Male Urinary Retention. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK538499/
Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med. 2022;12(6).
 Pathophysiology of Urine Retention
Neurogenic
Hyporeflexia of detrusor muscle

Dougherty JM, Aeddula NR. Male Urinary Retention. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK538499/
Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med. 2022;12(6).
Classification
Chronic
- Painless urinary retention caused by a
gradual increase in the volume of residual
urine

- still being able to urinate but not

smoothly

- Difficulty starting to urinate

Acute
- Sudden inability to urinate
accompanied by pain even
though the bladder feels full
- Unable to urinate at all
Diagnosis of
Urinary
Retention
 History
Taking

- Identifying Patient
- Main Symptom (Onset,
Characteristic, Aggravating
symptoms, Timing)
- Other symptoms (different to
each ethiologies)
- History (trauma, family,
treatment, etc)
PHYSICAL EXAMINATION
Inspection
Bulging in the lower
abdominal regio

Palpation
Palpable suprapubic mass
Tenderness
Percussion
Dullness in the suprapubic regio

Rectal Touche
Performed after urinary
retention is resolved,
depending on the cause, for
example an enlarged
prostate
Supporting Examination
Management
Therapy of Urinary
Retention
 Management

Catheterization

Bladder Puncture

Cystostomy

Dougherty JM, Aeddula NR. Male Urinary Retention. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Leslie SW, Rawla P, Dougherty JM. Female Urinary Retention. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024
Jan-.
TERIMA KASIH