II. Mechanism
- Bladder overdistention with Urinary Retention
- Usually have high residual urine
III. Causes
- Neurologic disease inhibiting detrussor activity
- Diabetes Mellitus
- Vitamin B12 Deficiency
- Herniated intervertebral disc
- Normal Pressure Hydrocephalus
-
Bladder outlet obstruction
- Prostatic enlargement (Benign Prostatic Hypertrophy)
- Urethral or Bladder neck stricture
- Pelvic tumors
- Uninhibited Urethral sphicter contraction
- Medication induced decreased Bladder contractility
- Medication induced increased Urethral sphincter tone
IV. Symptoms
- Incomplete Bladder emptying with need to strain to try to empty Bladder
- Urinary Frequency
- Urinary hesitancy
- Double voiding (Sensation to void again shortly after last void)
- Leakage of urine
V. Signs
- Palpable distended Bladder post voiding
- Post-void residual >200 cc (see Bladder Stress Test)
- Have patient void
- Insert Urinary Catheter and record Urine Volume
- Normally less than 50 cc
VI. Diagnosis
- Ultrasound assess Bladder volume
- Uroflowmetry (urodynamics)
VII. Management: General
- Correct underlying outflow obstruction
- Intermittent Self Catheterization
- Double Voiding
- Crede's Maneuver
VIII. Management: Betanachol (Urecholine)
- Mechanism
- Cholinergic Agonist
- Parasympathetic stimulation contracts detrussor
- Indications: Non-obstructive Bladder atony
- Contraindications