tailieunhanh - Urological Emergencies in Clinical Practice - part 2

trong trường hợp này có thể có ý nghĩa sâu sắc đối với bệnh nhân (dành cho bạn!). Người ta phải có một ngưỡng thấp bố trí một cộng hưởng từ tính khẩn cấp hình ảnh (MRI) quét của dây ngực, thắt lưng và xương cùng, và cauda equina trong các bệnh nhân hiện diện trong bí tiểu | 12 J. REYNARD in such cases can have profound implications for the patient and for you . One should have a low threshold for arranging an urgent magnetic resonance imaging MRI scan of the thoracic lumbar and sacral cord and of the cauda equina in patients who present in urinary retention with these additional symptoms or signs. Risk Factors for Postoperative Retention Postoperative retention may be precipitated by instrumentation of the lower urinary tract surgery to the perineum or anorectum gynaecological surgery bladder overdistention reduced sensation of bladder fullness preexisting prostatic obstruction and epidural anaesthesia. Postpartum urinary retention is not uncommon particularly with epidural anaesthesia and instrumental delivery. Urinary Retention Initial Management Urethral catheterisation is the mainstay of initial management of urinary retention. This relieves the pain of the overdistended bladder. If it is not possible to pass a catheter urethrally then a suprapubic catheter will be required. Record the volume drained this confirms the diagnosis determines subsequent management and provides prognostic information with regard to outcome from this treatment. IS IT ACUTE OR CHRONIC RETENTION There is a group of elderly men who are in urinary retention but who are not aware of it. This is so-called high-pressure chronic retention. Mitchell 1984 defined high-pressure chronic retention of urine as maintenance of voiding with a bladder volume of 800mL and an intravesical pressure above 30 cm H2O often accompanied by hydronephrosis Abrams et al. 1978 George et al. 1983 . Over time this leads to renal failure. The patient continues to void spontaneously and will often have no sensation of incomplete emptying. His bladder seems to be insensitive to the gross distention. Often the first presenting symptom is bedwetting. This is such an unpleasant and disruptive symptom that it will cause most people to visit their doctor. In such cases inspection of the .

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