Chronic Urinary Retention – Causes, Diagnosis and Management

Presentation Slides

Pdf Summary

The document is an educational outline for a webinar entitled "Chronic Urinary Retention – Causes, Diagnosis, and Management," delivered by Dr. John Stoffel. It features multiple sections focusing on definitions, neuro-biology, and treatments related to chronic urinary retention (CUR). Dr. Stoffel discusses a case of a 58-year-old woman presenting with urinary symptoms such as incomplete emptying and slow stream, highlighting the importance of measuring post-void residual (PVR) using ultrasound or catheterization in diagnosing CUR.<br /><br />Chronic urinary retention is defined by the American Urological Association (AUA) workgroup as repeated instances of elevated PVR of 300 mL persisting for at least six months and confirmed on separate occasions. The document elaborates on how CUR is different from incomplete emptying, which is often a subjective feeling rather than one that can be objectively measured. It touches upon causes of CUR, such as bladder outlet obstruction and underactive bladder, and mentions various neurological conditions associated with CUR.<br /><br />The webinar also covers testing procedures for CUR, including neurological exams, and discusses the implications of urethral sling operations, which may necessitate urethrolysis if bladder outlet obstruction (BOO) is present. The presentation explores underactive bladder physiology, neurological pathways, and includes urodynamics for differentiating between underactive bladder and obstructed bladder physiology.<br /><br />Treatment strategies are addressed, including medications like alpha blockers, interventional procedures like sacral neuromodulation, and catheterization techniques such as intermittent catheterization and suprapubic tube placement. CUR treatment paradigm involves risk stratification and symptom assessment, emphasizing the need for individualized management plans based on comprehensive evaluation and monitoring. Finally, various trials on CUR are briefly mentioned, noting ongoing research in this field.

Keywords

Chronic Urinary Retention

Diagnosis

Management

Post-Void Residual

Bladder Outlet Obstruction

Underactive Bladder

Neurological Conditions

Urodynamics

Sacral Neuromodulation

Catheterization