URINARY RETENTION

Etiology: bladder outlet obstruction (bladder ca, prostate ca, BPH, cervical ca, urethral stricture (at meatus), constipation, epidural tumor, drugs (TCAs, anticholinergics)

Treatment: 16 or 18 F urethral catheter- may use 10 ml of 2% lidocaine jelly into urethra prior to insertion of catheter (intermittent versus long-term)

*Post-obstructive diuresis may result in significant losses of Na and water: monitor!

URINARY INCONTINENCE

Rule out reversible causes: (DIAPPEERS) Delirium; Infection (do urinalysis); Atrophic urethritis/vaginitis; Pharmaceuticals (sedatives, ETOH, opiates, antipsychotics); Psychological (depression and behavioural), Endocrine (diabetes and hypercalcemia); Restricted mobility; Stool impaction

Stress: under-active urethral sphincter

Rx:

• Imipramine 10-25 mg po TID to QID; Pseudoephedrine 60 mg po QID
• Urge: bladder overactivity (detrusor instability)

Rx:

• Imipramine; Ditropan 2.5-5 mg po BID to QID; Detrol 2 mg po BID
• Overflow: bladder underactivity or sphincter over-activity or blockade

Rx:

• With BPH, Prazosin 3-12 mg/day in divided doses, BID to TID or Terazosin 1-10 mg po OD; incontinence pads; intermittent or long-term catheterization may be indicated