The Management of Acute

and Chronic Retention of

Urine: ISC versus Indwelling
catheterisation.
Roisin Hart
Senior Urology Nurse Specialist
Winchester
 Urinary Retention

The inability to voluntarily void urine

Categories of Urinary Retention
• Obstructive
• Infectious & Inflammatory
• Pharmacologic
• Neurologic
• Other
 Causes of Urinary Retention
Obstructive
• Benign prostatic hyperplasia
• Strictures
• Bladder calculi
• Faecal Impactation
• Phimosis / paraphimosis
• Benign/malignant pelvic masses
• Meatal Stenosis
 Causes of Urinary Retention
Obstructive
• Organ prolapse eg: cystocele, rectrocele,
uterine prolapse
• Pelvic mass – gynae malignancy
• Uterine fibroid / ovarian cyst
• Retroverted impacted gravid uterus
• Foreign bodies
 Infectious and Inflammatory
Causes
• Prostatitis
• Prostatic abscess
• Balantitis
• Cystitis
• Acute vulvovaginitis
• Bilharziasis
• Herpes simplex virus
 Pharmacologic causes
• Drugs with anticholingeric properties eg: tricylic
antidepressants (amitriptyline)
• Opioids
• Sympathomimetic drugs eg: oral decongestants
containing Ephedrine ( Sudafed)
• NSAIDs in men
• Antiparkinsonian agents (levodopa)
• Antipsychotics (chlopromazine)
• Muscle relaxants (Baclofen)
 Neurologic cause
AUTONOMIC OR PERIPHERAL NERVE
• Diabetes mellitus, Guillain-Barre syndrome
Pernicious anaemia, radical pelvic surgery
BRAIN
• CVA, MS, Tumour, Parkinson’s disease,
concussion
SPINAL CORD
• Haematoma / abscess / tumour, Cauda equine,
spina bifida occulta
 Other causes
• Post-op complications

• Pregnancy-associated retention

• Trauma eg: penile fracture or laceration

• Idiopathic detrusor failure

 Presentation of AUR
• Sudden inability to pass urine
• Suprapubic pain which typically causes
spasm
• Patient is acutely distressed
• Often longer history of bladder outflow
symptoms
• Bladder is visible,tender and palpable
• Patient is typically male
Effects of AUR
 Chronic Retention of Urine
• Completely different – maybe painless
• Incomplete emptying
• Often deny LUTS, nocturnal enuresis
• Large bladder, ? uraemic, ?anaemic, ?fluid
overloaded
• Large residual volume
• May diurese
• Bladder drainage may cause haematuria
 Acute or chronic?
• Large over distended
bladder
• Pressure on kidneys
and surrounding
organs
Acute on Chronic Retention
• Painful inability to
empty bladder
• Previous incomplete
bladder emptying
• Large volume on
catheterisation
Normal and overfilled bladder
 Management of AUR
• Decompression by Catheterisation
• Residual Volume < 800mls
• U&E’S and Creatinine normal
• Systemically well
• Home with catheter
• Follow-up plan
 Management of Chronic Retention
• Admit for observation including fluid balance
chart
• Check renal function
• Image upper tracts
• Manage post obstructive diuresis
• TWOC maybe unsuccessful
• May need TURP but may have irreversible
detrusor failure
• ISC an option or LTC
Acute or Chronic
Complications of Chronic retention
of urine
• Bilateral
Hydronephrosis
• Renal Inpairment
• Infections
• AUR
• Stones
Hydronephrosis
 Further Management
Varying local practices
• GP/DN→ catheterise→TWOC at home
• GP/DN →catheterise → refer to urology
• Attend A&E → catheterise →send home
• Attend A&E →catheterise→admit→TWOC
 Urethral vs. Suprapubic
catheterisation
URETHRAL SUPRAPUBIC
• Usually quick & easy • technical procedure
• Competent staff • Fewer staff
readily available competent
• Infection easily • Concerns over safety
introduced • Easier to TWOC
• Risk of Stricture • Reduce risk UTI
• Reduce stricture
 Urethral Catheterisation
• Check for sepsis prior to catheterisation
• Ensure correct catheter selection
• Always use an aseptic procedure
• Never force catheter against resistance
• Never inflate balloon in urethra
• Know your limitations
• Always record details and residual volume
• Think Paraphimosis
 Which Catheter?
• Nelaton Catheters
(ISC)

• Foley catheters
(Indwelling)
 Complications of Indwelling
Catheter
• Infection
• Irritation / Erosion
• Injury
• Stricture and False passage
• Stones / Encrustation causing blockage
• Spasm / Bypassing / Expulsion
• Malignant change
• Haematuria
 Complications of Indwelling
catheter (cont)
• Insertion difficulties
• Removal difficulties- non deflation
• Pain or discomfort
• Catheter expulsion
• Infected peri-urethral glands causing
abscess/fistula
• Reduced bladder capacity
• Reduced mobility
Benefits of Indwelling catheter
• Continence
• Preserves renal
function
• May reinstate social
independence
• Prevents high
pressure bladder
 Benefits of ISC
• Lower risk of infection
• Retains bladder capacity
• Allows normal function
• Protects renal function
• Avoids encrustation
 Benefits of ISC (cont)
• Maintains body image
• Promotes independence
• Increases morale and self esteem
• Reduces dependence on health
professionals
• Maintains sexual function
• Improves quality of life
 Limitations of ISC
May not be possible in those with:
• Profound physical disabilities or poor
manual dexterity.
• Psychological barriers to using technique.
• Small bladder capacity.
• Inadequate urethral pressure.
 ISC or Indwelling catheter
• Not mutually exclusive

• Depends on individuals needs

• Patient choice