Urinary retention
Encyclopedia
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia
(BPH), although it can also be caused by nerve dysfunction, constipation, infection, or medications (including anticholinergic
s, antidepressant
s, COX-2 inhibitor
s, amphetamine
s and opiates). Diagnosis and/or treatment may require use of a catheter
or prostatic stent
.
, nocturia
(need to urinate at night) and high frequency. Acute retention causing complete anuria
is a medical emergency, as the bladder may distend (stretch) to enormous sizes and possibly tear if not dealt with quickly. If the bladder distends enough it will begin to become painful. The increase in pressure in the bladder can also prevent urine entering from the ureters or even cause urine to pass back up the ureters and get into the kidneys, causing hydronephrosis, and possibly pyonephrosis, kidney failure and sepsis. A person should go straight to an emergency department as soon as possible if unable to urinate when having a painfully full bladder.
In the prostate
Penile urethra
Other
Paruresis
, inability to urinate in the presence of others (such as in a public restroom), may also be classified as a type of urinary retention, although it is psychological rather than biological.
Determination of the serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate cancer, though this is also raised in BPH and prostatitis. A TRUS biopsy of the prostate (trans-rectal ultra-sound guided) can distinguish between these prostate conditions. Serum urea
and creatinine
determinations may be necessary to rule out backflow kidney damage. Cystoscopy may be needed to explore the urinary passage and rule out blockages.
In acute cases of urinary retention where associated symptoms in the lumbar spine are present such as pain, numbness (saddle anesthesia), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess cauda equina syndrome.
. In some people, the disorder starts gradually but in others it may appear suddenly. Acute urinary retention is a medical emergency
and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover one can develop severe sweating, chest pain
, anxiety
and high blood pressure
. Other patients may develop a shock like condition and may be require an admission to the hospital. It is not unusual for an individual to develop a heart attack
after suffering acute urinary retention. Other more serious complications of untreated urinary retention include bladder
damage and chronic kidney failure
. Urinary retention is a disorder which is treated in a hospital and the quicker one seeks treatment, the fewer the complications.
In the longer term, obstruction of the urinary tract may cause:
, placement of a prostatic stent
or suprapubic cystostomy
relieves the retention. In the longer term, treatment depends on the cause. Benign prostatic hypertrophy may respond to alpha blocker
and 5-alpha-reductase inhibitor
therapy, or surgically with prostatectomy
or transurethral resection of the prostate
(TURP). Older patients with ongoing problems may require continued intermittent self catheterization. 5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal.
or a Foley catheter
that is emplaced with a small inflatable bulb that holds the catheter in place.
Intermittent catheterization can be done by a health care professional (nurse/ doctor) or by the patient himself /herself (clean intermittent self catheterization). Intermittent catheterization performed at the hospital will be a sterile technique done by nurses /doctores, while patients can be taught to use a self catheterization technique in one simple demonstration, and that reduces the rate of infection from longer term Foley catheters. Self catheterization requires doing the procedure every 3 or 4 hours 4-6 times a day. The chronic
form of urinary retention may require some type of surgical
procedure. While both procedures are relatively safe, complications can occur.
In acute urinary retention, the treatment requires urgent placement of a urinary catheter (tube) into the urethra
and into the bladder. These catheters are usually inserted by health care professionals. However, if the procedure is not accomplished in a sterile
fashion, it can introduce bacteria
into the bladder. This can result in an infection of the entire urinary tract. Therefore, sterile technique is a must when inserting a foley catheter
. Careful washing of hands, meatus
, and reusable catheters are also necessary with clean self catheterization techniques.
Sometimes the permanent urinary catheter may cause discomfort and pain which often lasts for several days. The urinary catheter must be placed into the bladder and not near the prostate
gland. Placement of the catheter near the prostate can lead to bleeding and significant irritation
.
In most patients with benign prostate hyperplasia (BPH), a procedure known as transurethral resection of the prostate
(TURP) is performed to relieve bladder obstruction. The surgery is done with a small lighted instrument which is inserted into the urethra under anesthesia. The surgeon can core out the enlarged prostate and relieve obstruction. However, the procedure does have risks. There are risks of anesthesia which may include allergy
to medications or low blood pressure
which results from spinal anesthesia.
The surgical complications from TURP include a bladder infection, bleeding from the prostate, scar formation, inability to hold urine and inability to have an erection. The majority of these complications are short lived and most individuals recover fully within 6–12 months.
Some people with BPH are treated with medications like finasteride
or dutasteride
to decrease prostate enlargement. The drugs only work for mild cases of BPH but also have mild side effects. Some of the medications decrease libido
and may cause dizziness
, fatigue and lightheadedness
. Unfortunately, medications only work in less than 5 percent of individuals with BPH.
. This disorder starts around age 50 and symptoms may appear after 10–15 years. BPH is a progressive disorder and narrows the neck of the bladder leading to urinary retention. By the age of 70, almost 10 percent of males have some degree of BPH and 33% have it by the eighth decade of life. While BPH rarely causes sudden urinary retention, the condition can become acute in the presence of certain medications (blood pressure
pills, anti histamine
s, antiparkinson medications), after spinal anaesthesia
or stroke.
In young males, the most common cause of urinary retention is infection of the prostate (known as "acute prostatitis
"). The infection is acquired during sexual intercourse and presents with low back pain, penile discharge, low grade fever
and an inability to pass urine. The exact numbers of individuals with acute prostatitis is unknown because many do not always seek treatment. In the USA, at least 1-3 percent of males under the age of 40 develop urinary difficulty as a result of acute prostatitis. Most physicians and other health care professionals are aware of these disorders. Worldwide, both BPH and acute prostatitis have been found to occur in males of all races, color and ethnic backgrounds. Cancers of the urinary tract can cause urinary obstruction but the process is more gradual. Bladder cancer
, prostate or ureters can gradually obstruct urine output. Cancers often present with blood in the urine, weight loss
, lower back pain or gradual distension in the flanks.
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH), although it can also be caused by nerve dysfunction, constipation, infection, or medications (including anticholinergic
Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
s, antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s, COX-2 inhibitor
COX-2 inhibitor
COX-2 selective inhibitor is a form of non-steroidal anti-inflammatory drug that directly targets COX-2, an enzyme responsible for inflammation and pain. Targeting selectivity for COX-2 reduces the risk of peptic ulceration, and is the main feature of celecoxib, rofecoxib and other members of this...
s, amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
s and opiates). Diagnosis and/or treatment may require use of a catheter
Urinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
or prostatic stent
Prostatic stent
A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
.
Signs and symptoms
Urinary retention is characterised by poor urinary stream with intermittent flow, straining, a sense of incomplete voiding and hesitancy (a delay between trying to urinate and the flow actually beginning). As the bladder remains full, it may lead to incontinenceUrinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
, nocturia
Nocturia
Nocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
(need to urinate at night) and high frequency. Acute retention causing complete anuria
Anuria
Anuria means nonpassage of urine, in practice is defined as passage of less than 50 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stones or tumours. It may occur with end stage renal...
is a medical emergency, as the bladder may distend (stretch) to enormous sizes and possibly tear if not dealt with quickly. If the bladder distends enough it will begin to become painful. The increase in pressure in the bladder can also prevent urine entering from the ureters or even cause urine to pass back up the ureters and get into the kidneys, causing hydronephrosis, and possibly pyonephrosis, kidney failure and sepsis. A person should go straight to an emergency department as soon as possible if unable to urinate when having a painfully full bladder.
Causes
In the bladder- Detrusor sphincter dyssynergiaBladder sphincter dyssynergiaBladder sphincter dyssynergia is a consequence of a neurological pathology such as spinal injury or multiple sclerosis that disrupts central nervous system regulation of the micturition reflex resulting in dyscoordination of...
- Neurogenic bladder (commonly pelvic splanchic nerve damage, cauda equina syndrome, descending cortical fibers lesion, pontine micturation or storage center lesions, demyelinating diseases or Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
) - IatrogenicIatrogenesisIatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...
(doctor-caused) scarring of the bladder neck (commonly from removal of indwelling catheters or cystoscopyCystoscopyCystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
operations) - Damage to the bladder
In the prostate
- Benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
- Prostate cancerProstate cancerProstate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
and other pelvic malignanciesCancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the... - Prostatitis
Penile urethra
- Congenital urethral valves
- PhimosisPhimosisPhimosis , from the Greek phimos ), is a condition where, in men, the foreskin cannot be fully retracted over the glans penis...
or pinhole meatus - CircumcisionCircumcisionMale circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
- Obstruction in the urethra, for example a metastasis or a precipitated pseudogout crystal in the urine
- STD lesions (gonorrhoea causes numerous strictures, leading to a "rosary bead" appearance, whereas chlamydia usually causes a single stricture)
Other
- ParuresisParuresisParuresis is a type of phobia in which the sufferer is unable to urinate in the presence of others, such as in a public restroom. It most commonly affects males, though there are female sufferers too...
("shy bladder syndrome")- in extreme cases, urinary retention can result - Consumption of some psychoactive substancesPsychoactive drugA psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
, mainly stimulantStimulantStimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
s, such as MDMAMethylenedioxymethamphetamineMDMA is an entactogenic drug of the phenethylamine and amphetamine class of drugs. In popular culture, MDMA has become widely known as "ecstasy" , usually referring to its street pill form, although this term may also include the presence of possible adulterants...
and amphetamineAmphetamineAmphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
. - Use of NSAIDs or drugs with anticholinergicAnticholinergicAn anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
properties. - Stones or metastases can theoretically appear anywhere along the urinary tract, but vary in frequency depending on anatomy
Paruresis
Paruresis
Paruresis is a type of phobia in which the sufferer is unable to urinate in the presence of others, such as in a public restroom. It most commonly affects males, though there are female sufferers too...
, inability to urinate in the presence of others (such as in a public restroom), may also be classified as a type of urinary retention, although it is psychological rather than biological.
Diagnosis
Urine flow tests may aid in establishing the type of micturition (urination) abnormality. Common findings, determined by ultrasound of the bladder, include a slow rate of flow, intermittent flow, and a large amount of urine retained in the bladder after urination. A normal test result should be 20-25 mL/sec peak flow rate. A post-void residual urine greater than 50 ml is a significant amount of urine and increases the potential for recurring urinary tract infections. In adults older than 60 years, 50-100 ml of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. In chronic retention, ultrasound of the bladder may show massive increase in bladder capacity (normal capacity being 400-600 ml).Determination of the serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate cancer, though this is also raised in BPH and prostatitis. A TRUS biopsy of the prostate (trans-rectal ultra-sound guided) can distinguish between these prostate conditions. Serum urea
Urea
Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....
and creatinine
Creatinine
Creatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body...
determinations may be necessary to rule out backflow kidney damage. Cystoscopy may be needed to explore the urinary passage and rule out blockages.
In acute cases of urinary retention where associated symptoms in the lumbar spine are present such as pain, numbness (saddle anesthesia), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess cauda equina syndrome.
Complications
Urinary retention often occurs without warning. It is basically the inability to pass urineUrine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
. In some people, the disorder starts gradually but in others it may appear suddenly. Acute urinary retention is a medical emergency
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover one can develop severe sweating, chest pain
Chest pain
Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and high blood pressure
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
. Other patients may develop a shock like condition and may be require an admission to the hospital. It is not unusual for an individual to develop a heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
after suffering acute urinary retention. Other more serious complications of untreated urinary retention include bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
damage and chronic kidney failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. Urinary retention is a disorder which is treated in a hospital and the quicker one seeks treatment, the fewer the complications.
In the longer term, obstruction of the urinary tract may cause:
- Bladder stones
- AtrophyAtrophyAtrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations , poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself...
of the detrusor muscle (atonic bladder is an extreme form) - HydronephrosisHydronephrosisHydronephrosis is distension and dilation of the renal pelvis calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney...
(congestion of the kidneys) - HypertrophyHypertrophyHypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It should be distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number...
of the detrusor muscle (the muscle which squeezes the bladder to empty it during urination) - Diverticula (the formation of pouches) in the bladder wall (which can lead to stones and infection)
Treatment
In acute urinary retention, urinary catheterizationUrinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
, placement of a prostatic stent
Prostatic stent
A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
or suprapubic cystostomy
Suprapubic cystostomy
A suprapubic cystostomy is a surgically-created connection between the urinary bladder and the skin which is used to drain urine from the bladder in individuals with obstruction of normal urinary flow...
relieves the retention. In the longer term, treatment depends on the cause. Benign prostatic hypertrophy may respond to alpha blocker
Alpha blocker
Alpha-1 blockers constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles.-Pharmacology:...
and 5-alpha-reductase inhibitor
5-alpha-reductase inhibitor
5α-Reductase inhibitors are a group of drugs with antiandrogenic activity, used in the treatment of benign prostatic hyperplasia and androgenic alopecia...
therapy, or surgically with prostatectomy
Prostatectomy
A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
or transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
(TURP). Older patients with ongoing problems may require continued intermittent self catheterization. 5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal.
Complications
The acute urinary retention is treated by placement of a urinary catheter (small thin flexible tube) into the bladder. This can be either an intermittent catheterIntermittent catheter
Intermittent catheterisation is an effective technique for people who need catheter-based bladder management. Intermittent catheterisation is considered the ‘gold-standard’ of care for bladder emptying, and this approach is supported by several international and national guidelines on urinary...
or a Foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
that is emplaced with a small inflatable bulb that holds the catheter in place.
Intermittent catheterization can be done by a health care professional (nurse/ doctor) or by the patient himself /herself (clean intermittent self catheterization). Intermittent catheterization performed at the hospital will be a sterile technique done by nurses /doctores, while patients can be taught to use a self catheterization technique in one simple demonstration, and that reduces the rate of infection from longer term Foley catheters. Self catheterization requires doing the procedure every 3 or 4 hours 4-6 times a day. The chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
form of urinary retention may require some type of surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
procedure. While both procedures are relatively safe, complications can occur.
In acute urinary retention, the treatment requires urgent placement of a urinary catheter (tube) into the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
and into the bladder. These catheters are usually inserted by health care professionals. However, if the procedure is not accomplished in a sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
fashion, it can introduce bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
into the bladder. This can result in an infection of the entire urinary tract. Therefore, sterile technique is a must when inserting a foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
. Careful washing of hands, meatus
Meatus
In anatomy, a meatus is a natural body opening or canal .Examples include:* the external acoustic meatus, the opening of the ear canal...
, and reusable catheters are also necessary with clean self catheterization techniques.
Sometimes the permanent urinary catheter may cause discomfort and pain which often lasts for several days. The urinary catheter must be placed into the bladder and not near the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
gland. Placement of the catheter near the prostate can lead to bleeding and significant irritation
Irritation
Irritation or exacerbation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant...
.
In most patients with benign prostate hyperplasia (BPH), a procedure known as transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
(TURP) is performed to relieve bladder obstruction. The surgery is done with a small lighted instrument which is inserted into the urethra under anesthesia. The surgeon can core out the enlarged prostate and relieve obstruction. However, the procedure does have risks. There are risks of anesthesia which may include allergy
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
to medications or low blood pressure
Hypotension
In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...
which results from spinal anesthesia.
The surgical complications from TURP include a bladder infection, bleeding from the prostate, scar formation, inability to hold urine and inability to have an erection. The majority of these complications are short lived and most individuals recover fully within 6–12 months.
Some people with BPH are treated with medications like finasteride
Finasteride
Finasteride is a synthetic antiandrogen that inhibits type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone...
or dutasteride
Dutasteride
Dutasteride is a dual 5-a reductase inhibitor that inhibits conversion of testosterone to dihydrotestosterone ....
to decrease prostate enlargement. The drugs only work for mild cases of BPH but also have mild side effects. Some of the medications decrease libido
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
and may cause dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....
, fatigue and lightheadedness
Lightheadedness
Light-headedness is a common and often unpleasant sensation of dizziness and/or feeling that one may be about to faint, which may be transient, recurrent, or occasionally chronic. In some cases, the individual may feel as though his or her head is weightless. The individual may also feel as...
. Unfortunately, medications only work in less than 5 percent of individuals with BPH.
Epidemiology
Urinary retention is a common disorder in elderly males. The most common cause of urinary retention is benign prostate hypertrophyHypertrophy
Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It should be distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number...
. This disorder starts around age 50 and symptoms may appear after 10–15 years. BPH is a progressive disorder and narrows the neck of the bladder leading to urinary retention. By the age of 70, almost 10 percent of males have some degree of BPH and 33% have it by the eighth decade of life. While BPH rarely causes sudden urinary retention, the condition can become acute in the presence of certain medications (blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
pills, anti histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
s, antiparkinson medications), after spinal anaesthesia
Spinal anaesthesia
Spinal anaesthesia , also called spinal analgesia or sub-arachnoid block , is a form of regional anaesthesia involving injection of a local anaesthetic into the subarachnoid space, generally through a fine needle, usually 9 cm long...
or stroke.
In young males, the most common cause of urinary retention is infection of the prostate (known as "acute prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
"). The infection is acquired during sexual intercourse and presents with low back pain, penile discharge, low grade fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
and an inability to pass urine. The exact numbers of individuals with acute prostatitis is unknown because many do not always seek treatment. In the USA, at least 1-3 percent of males under the age of 40 develop urinary difficulty as a result of acute prostatitis. Most physicians and other health care professionals are aware of these disorders. Worldwide, both BPH and acute prostatitis have been found to occur in males of all races, color and ethnic backgrounds. Cancers of the urinary tract can cause urinary obstruction but the process is more gradual. Bladder cancer
Bladder cancer
Bladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
, prostate or ureters can gradually obstruct urine output. Cancers often present with blood in the urine, weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
, lower back pain or gradual distension in the flanks.