Causes, symptoms and treatment of paradoxical ischuria. What is urinary retention? Causes and mechanism of development

Urinary retention or ischuria is not a disease. This is a symptom complex caused by the inability to urinate. The accumulation of urine in the bladder reaches a liter or more. The person experiences strong urges and pain, but cannot urinate on his own.

The situation occurs more often in men, in women - much less often. It is impossible to cope with it on your own. The administration of antispasmodic drugs is ineffective. The greatest difficulties in diagnosis are caused by paradoxical ischuria. It is manifested by bladder overflow and spontaneous urine leakage. Residual urine creates a feeling of incomplete emptying.

What types of ischuria do doctors take into account?

Types of ischuria differ according to the clinic. Based on the remaining ability to urinate, the following are distinguished:

• complete ischuria - the patient even uses muscles abdominals and straining cannot excrete urine, excretion is possible only with a catheter;
• incomplete – there is partial outflow, but a large volume of residual urine (up to a liter) always remains.

By length of delay:

• acute – occurs against the background of normal urination, suddenly, in the form of an attack;
• chronic – occurs unnoticed by the patient and is detected only when signs of complications caused by prolonged stagnation appear (cystitis, pyelonephritis).

Based on the totality of these manifestations, the following options are observed in practice: clinical course. Acute complete ischuria is characterized by a sudden development, the outflow of urine is stopped. The patient has complaints:

• to paroxysmal acute pain above the pubis;
• strong urge to urinate.

Upon examination, a roller-like protrusion in the lower abdomen and pain in the bladder area are revealed. The condition should not be confused with anuria, in which there is no urine in the bladder due to impaired filtration function of the kidneys. Therefore, there is no painful urge to urinate.

Acute incomplete – also develops quickly, but urine is excreted in small portions and complete emptying does not occur. Patients constantly have heaviness in the lower abdomen, periodically turning into severe pain. Chronic complete – as a consequence of a long-term disease, it develops over a month or several years. Urine is removed only by a catheter.

The most common cause of chronic ischuria in men is prostatic hyperplasia

Chronic incomplete - emptying occurs at 20% of the required volume. The remaining urine must be removed with a catheter. Acute forms often come under the influence of urologists. Paroxysmal pain forces patients to consult a doctor. Urine excretion and subsequent diagnosis make it possible to find out the cause, apply the optimal treatment method and prevent complications.

Causes and mechanism of occurrence

The factors that provoked ischuria are very diverse. Mechanical – for diseases that compress urinary tract or become a barrier to urine flow:

• prostate adenoma in men;
• neoplasms;
• polyps;
• blockage of the urethral canal by blood clots due to injuries, hematuria;
• urethral adhesions;
• phimosis and paraphimosis;
• stones in the neck of the bladder.

Possible compression due to neighboring organs (tumor growth, abscesses); in children, outflow disturbance due to congenital anomalies.

Neurogenic – include diseases nervous system:

• brain tumors;
• consequences of stroke;
• myelitis;
• traumatic injury spinal cord.

Functional and reflex – these include:

• postoperative complications in the form of innervation disturbances;
• emotional excitement;
• consequences of difficult childbirth in women;
• conditions associated with prolonged bed rest, uncomfortable position for urination;
• toxic effect sleeping pills, alcohol, drugs, atropine compounds, a group of ganglion blockers;
• reaction to pain state of shock;
• effects of anesthesia;
• mental changes(hysteria) with spasmodic contraction of the urethral muscles.

The main role in the mechanism of development of ischuria is played by:

• increased resistance to urine flow;
• decreased contractility of the bladder expulsion muscle (detrusor).

Resistance increases against the background of mechanical obstruction to outflow. An increase in pressure inside the bladder leads to its overdistension, subsequent dystrophic changes and replacement of muscle fibers with connective tissue.

Paradoxical ischuria is more often formed during a long-term chronic course of diseases. In this case, there is a combination of loss of tone of the detrusor and urethral sphincter. Therefore, urine is “passed” through the canal in drops.

How is diagnosis carried out?

To confirm the fact of ischuria, it is necessary to find out from the patient or his relatives how the pathology developed, whether there are any diseases of the urinary organs, ask about previous injuries, diseases of the nervous system or mental disorders.

Protrusion of the bladder is visible when examining the abdomen

The upper border protrudes above the womb. A soft, tense formation is palpated. Due to the constant urge, patients are very restless and complain of pain. It is necessary to assist the patient and remove urine with a catheter. To prevent increased urethral spasm, antispasmodic drugs (Atropine, Platyphylline) are administered before the procedure. It is rarely necessary to use puncture and suction with a syringe.

The next step is to find out the cause of ischuria. To do this, the patient must undergo a complete examination by a urologist. Women are required to consult a gynecologist with bimanual palpation of the uterus and appendages. Men are examined through the rectum by a urologist and the prostate is palpated.

List of necessary studies:

1. A urine test will reveal the inflammatory process and its causative agents. In case of bacteriuria, a study using the tank method is prescribed. sowing
2. A blood test can indirectly judge the activity of the inflammatory process; biochemical tests for residual nitrogen, protein, and electrolytes help establish the initial stage of renal failure.
3. Cystoscopy is a method of viewing the inner surface of the bladder. The urologist examines the orifices of the ureters, neck, and triangle area. Polyps and tumors are most often localized in them. If malignant growth is suspected, material is taken for a biopsy.
4. Contrast research methods involve the injection of a dye into a vein (excretory) or into the bladder (retrograde), which is visible during subsequent examinations. x-rays. In this way, developmental anomalies, tumor growth, and dysfunction are detected.
5. An abdominal ultrasound helps check nearby organs.
6. TRUSY - necessary method to determine the size of the prostate gland in men.

Stagnation of urine in the bladder spreads higher, the ureters and pelvis expand

What are the possible complications?

The patient’s refusal to undergo examination is fraught with a repetition of the attack of acute delay or transition to chronic course. Serious consequences of missing treatment can be:

• the development of chronic inflammatory diseases of the urinary organs (pyelonephritis, glomerulonephritis, cystitis) due to the high probability of infection of residual urine and reflux into higher structures;
• significant expansion of the renal pelvis (hydronephrosis) with compression of the parenchymal tissue of the kidney;
• accelerated formation of stones from salt sediment with attacks urolithiasis, blood in the urine;
• chronic failure kidney

Ishuria can be eliminated without a trace at the initial stage. Against the background of complications, constant treatment of chronic diseases will be required, and urinary retention will have to be dealt with only by catheterization or surgery.

One of the problems associated with the process of urination is urinary retention, or ischuria. This pathological condition can occur in the entire population, but most often it affects men. Persons suffering from this disease are unable to completely empty their bladder, or urine comes out drop by drop and with great difficulty. A person may suspect that he has this disease if his stomach begins to enlarge, discomfort occurs in the lower abdomen, and the urge to urinate becomes more frequent. What reasons lead to the development of ischuria, why is it dangerous for men and is it possible to cure it?

There are different types of urinary retention, which occur in different ways. It can be acute and chronic (complete and incomplete), as well as paradoxical.

Acute ischuria of the full form appears unexpectedly. Painful sensations occur in the abdomen or bladder, and there is a feeling of fullness of the latter. The urge to urinate becomes more frequent. The incomplete acute form leads to the release of urine in very small quantities.

Chronic ischuria is a pathology that can be completely asymptomatic for some time, but as it develops, it begins to manifest itself more and more, reminding itself. Full form characterized by the fact that a person cannot independently carry out the process of urination; only a catheter installed in the urethra helps him in this. In the incomplete chronic form, a man is able to empty himself, but not completely, and part of the urine remains in the bladder.

There is also such a variety as paradoxical ischuria. It is characterized by the fact that the bladder begins to stretch very much, atony and excessive enlargement of the sphincters occur, which is why the man is not able to go to the toilet on his own. That is why paradoxical ischuria leads to the fact that urine begins to be released in drops from the urethra.

Causes of acute ischuria

Urinary retention occurring in acute form, occurs suddenly. Basically, it is a complication of prostate adenoma. As this grows benign tumor The section of the urethra passing through the prostate begins to change: it stretches in length and bends. This leads to the fact that urine begins to linger in the urethra, and its outflow is carried out with great difficulty. Prostate adenoma leads to swelling of the gland itself and an increase in its size, which also contributes to the occurrence of acute ischuria.

In addition, the following events lead to the formation of pathology:

• spinal cord or brain injuries;
• surgery on the spine or abdominal organs, as a result of which the patient is prescribed long-term bed rest;
• severe alcohol intoxication;
• hypothermia of the body;
• forced delay of urination;
• multiple sclerosis;
• overdose of sleeping pills;
• poisoning narcotic substances;
• physical tension and stress;
• penetration of blood clots into the bladder in a man.

Causes of chronic ischuria

This form of urinary retention occurs as a result of exposure to the following pathological factors:

• Injury or damage to the urethra or bladder.
• Blockage of the organs responsible for excreting urine. The lumen of the canal may close as a result of a stone or other foreign body getting into it. Usually either the vesicourethral segment or the urethra itself is blocked. In the first case, this may occur due to a malignant tumor of the bladder, a polyp, or a congenital obstruction of the segment. In the second case, blockage occurs due to protrusion of one of the walls of the bladder or narrowing of the lumen of the urethra.
• Constriction of the bladder. It is caused by pathologies of the genital organs, such as prostatitis, balanoposthitis, cancer, phimosis, prostate sclerosis. A man’s bladder can also be compressed due to pathologies of the organs located in the pelvis. These include perineal pathology, groin hernia, rectal cancer, and aneurysms of the hypogastric arteries.

In addition, the chronic form appears in diseases of the central nervous system, such as neurogenic bladder dysfunction. In this case, spastic ischuria occurs, in which this organ contracts and the urethral sphincter relaxes involuntarily.

Diagnostics

If you notice at least one of the listed symptoms, you should immediately consult a doctor who will conduct the necessary research and make the correct diagnosis.

First, the specialist examines the history of the disease and complaints, as well as the patient’s lifestyle. After this, the doctor examines the patient, palpating the enlarged bladder in the lower abdomen. This diagnostic method makes it possible to distinguish ischuria from anuria, in which there is no urination at all.

The patient must undergo a general blood test to determine signs of the inflammatory process, and thanks to a general urine test, pathological changes in the kidneys and bladder.

A biochemical blood test determines whether there are any abnormalities in the functioning of the kidneys.

An abdominal ultrasound performed after the patient urinates can measure the amount of urine that remains in the bladder after urination.

How is ischuria treated?

This disease is most often treated by catheterization. The essence of this procedure is as follows: a special metal catheter is inserted into the bladder through the urethra, which helps urine exit this organ. These devices are also made of rubber. The end of the catheter has a beak-like bend to allow it to pass better into the bladder. It can stay in a man’s body from a day to two weeks. After improvement occurs, the person begins to urinate normally without any delays. For greater effect, the doctor can simultaneously prescribe alpha blockers with this procedure, which are also used to treat prostate adenoma.

In addition, urine can be removed from the bladder using capillary puncture. In this case, a long needle is inserted into the patient under anesthesia 1.5 cm above the pubis and to a depth of 5 cm. The outer end of the needle should have a soft tube. This instrument must be placed into the bladder to help urine flow out of the bladder through the tube. As soon as the organ is free of urine, the needle is removed. This procedure is performed several times a day.

Complications

In the absence of timely diagnosis and treatment of ischuria, the following complications may occur:

Conclusion

Thus, it has now become clear what ishuria is. This is urinary retention, occurring in acute and chronic forms. It is necessary to diagnose the disease in a timely manner and treat it in a timely manner. For this purpose, doctors must choose the most suitable way so that in the future the man will not have problems with urination.

Description:

Ischuria - the inability to empty the bladder independently - is one of the most common causes emergency hospitalization patients to the hospital. There are acute and chronic, complete and incomplete urinary retention.

With incomplete urinary retention, a certain amount of urine (more than 20 ml) remains in the bladder after urination. Residual urine can be detected by inserting a catheter or x-ray examination, radioisotope renography and ultrasound. Incomplete urinary retention often becomes complete, especially in patients with adenoma, prostate cancer or stricture of the urethra, as well as in children with various congenital diseases vesico-urethral segment.

Acute delay urination occurs suddenly, as if in the midst of complete well-being, for example, when a stone or polyp on a long stalk enters the urethra with a stream of urine.

Symptoms:

Diagnosis of acute urinary retention does not cause difficulties (inability to empty the bladder independently, acute bursting pain in the lower abdomen). On examination, a spherical protrusion above the pubis is detected, especially clearly defined in thin patients and children. Palpation reveals a dense elastic formation above the pubis.

Causes:

Acute retention can be caused by trauma to the urethra or a foreign body. It also develops against the background of chronic urinary retention. Causes, causing delay urination can be divided into two groups:

   1. Pathological changes in the urinary organs or their compression:
            1. Traumatic injuries (trauma, crushing, separation of the urethra).
            2. Blockage of the lumen of the urethra:
                     1.at the level of the vesicourethral segment (unilateral or bilateral ureterocele, stone, polyp, bladder, congenital obstruction of the vesicourethral segment);
                     2.at the level of the urethra (valve, diverticulum, foreign body, stone, tumor, post-inflammatory).
            3. Compression of the urethra by pathologically altered organs genitourinary system(for adenoma, cancer, cyst, abscess, prostate sclerosis, prostatitis, phimosis, paraphimosis, balanoposthitis).
            4. Compression of the urethra by pathologically altered organs of the pelvic cavity (rectal cancer, uterine tumors, inguinal hernias, hypogastric artery, perineum, etc.).
   2. Diseases of the nervous system (neurogenic bladder dysfunction).

The causes of disruption of the processes of contraction and relaxation of the detrusor and vesicourethral segment include tumors, inflammatory diseases, spinal cord and brain injuries, spinal cord hernias, and disruption of the peripheral innervation of the bladder after surgery on the pelvic organs. This group of reasons also includes reflex retention of urination after surgical interventions, childbirth, spinal. At the same time, it must be remembered that not everyone healthy man may urinate in horizontal position.
When the urethra is compressed or its lumen is obstructed, urination becomes more frequent and the contractility of the detrusor increases. There is uneven hypertrophy of the bladder muscles, resulting in the so-called trabecular bladder. This is the elevation of individual muscle fibers above the surface of the mucous membrane of the bladder. With detrusor hypertrophy, blood circulation and trophism of the bladder are disrupted, and false and true diverticula can occur. The amount of residual urine increases, and subsequently complete urinary retention occurs. If the cause that disrupts the outflow of urine is not eliminated, paradoxical ischuria occurs. In this case, urine, having overcome the stretched vesicourethral segment, regardless of the will of the patient, is constantly released in drops from the urethra, that is, against the background of complete urinary retention, urination is observed. Bladder rupture is possible in patients in a state of alcohol intoxication, with blows to the bladder area, falls. With complete and incomplete retention of urination, all conditions arise that contribute to the development of the inflammatory process in the bladder -. IN initial stages The mucous membrane is involved in the inflammatory process, and subsequently the submucosal, muscular and all layers of the bladder. This development of the inflammatory process is especially often observed in patients with damage to the brain and spinal cord.

In most cases, the reasons that cause urinary retention also cause a violation of the outflow of urine from the kidneys. A good example is patients with prostate adenoma. Hypertrophied paraurethral glands simultaneously compress both the urethra and the orifices of the ureters. The radiograph reveals a narrowed lumen of the elevated distal ureter. It has the shape of a fishhook, and in these cases, the disruption of the outflow of urine from the ureters is caused by the pressure of both the adenomatous nodes themselves and urine, a large amount of which is in the bladder. In patients with prostate adenoma, paradoxically, it may also occur, which is also typical for children with contractures of the vesicourethral segment, hydronephrosis and megadolihoureter.

Impaired urine outflow from the kidneys, vesicoureteral, and subsequently renal pelvic reflux disrupt microcirculation, reduce the level of glomerular filtration and tubular reabsorption and create conditions for the penetration of ascending infection and the occurrence of pyelonephritis. Moreover, under these conditions, serous quickly turns into purulent (apostematosis, carbunculosis) and leads to kidney death, urosepsis and renal failure.

Patients with prostate adenoma already in the 1st stage (when the person is practically healthy) have pyelonephritis and latent. Patients with long-term untreated urinary retention usually die from renal failure and urosepsis.

Treatment:

Treatment of patients with urinary retention includes two aspects. This is the removal of urine from the bladder and the elimination of the causes that caused urinary retention. Patients with acute urinary retention and those suffering from incomplete urinary retention for a long time, weakened chronic pyelonephritis and renal failure, require immediate removal of urine from the bladder. Emptying the bladder can be accomplished by catheterization, suprapubic capillary puncture, trocar cystostomy, and epicystostomy.

The most common method of excreting urine is. It is carried out under aseptic conditions. In order to prevent inflammatory processes and urethral fever, antibiotics are prescribed. For catheterization of the bladder, metal and rubber catheters are used. Position the patient on his back, preferably in a gynecological chair. The doctor stands near the couch or chair with right side. With three fingers of the left hand he takes the penis by the head, with his right hand he inserts the catheter into the urethra, pulling the latter onto the instrument to the external sphincter of the bladder. Then the penis, together with the catheter, is brought to the anterior abdominal wall and gradually lower it down towards the scrotum. At this moment, overcoming the slight resistance of the vesicourethral segment, the catheter enters the bladder. The use of a metal catheter, especially in the absence of skills, does not eliminate the danger of the formation of false passages in the urethra and prostate gland, which can lead to the development of urethral fever, orchiepididymitis, and urinary leakage. It is safer to insert Nelaton and Timan rubber catheters into the urethra. The latter has a beak-shaped bend at the distal end and passes better along back wall urethra to bladder. The advantage of rubber catheters is that they can be left in the urethra for 2-3 days, and sometimes up to 2 weeks. The presence of mucus, blood, pus, and salts in the urine makes it difficult to drain the bladder with a catheter, especially when left in place for a long time.

Complications of catheterization. Even with a single catheterization, infection of the lower urinary tract (urethritis, cystitis), microtrauma of the mucous membrane of the urethra is possible, which can lead to the development of pyelonephritis and urosepsis. Catheterization, especially with a metal catheter, can cause urethrorrhagia, which forces you to abandon the attempt to empty the bladder.

Contraindications to catheterization: trauma to the urethra, acute.

The second way to remove urine from the bladder during urinary retention is capillary puncture of the bladder, which is performed by patients in cases where insertion of a catheter is impossible or contraindicated. It is advisable to carry out capillary puncture of the bladder in patients with stage 2 prostate adenoma (complete urinary retention) for the purpose of examining and deciding on the advisability of performing a simultaneous adenomectomy. The bladder is punctured above the pubis, 1-2 cm away from midline. The puncture can be performed 2-3 times a day.

Complications of capillary puncture. According to many authors, during capillary puncture, extensive urinary leaks are observed, especially in patients with a thin bladder wall. Capillary puncture is difficult in people with overweight bodies. It is ineffective if there are blood clots, pus, salts, etc. in the urine.

Suprapubic epicystostomy. The operation has been used for a long time and the technique for performing it is well known. A suprapubic vesical fistula is formed, providing sufficient drainage of the bladder using a Petzer, Foley catheter, and rubber drains. Being relatively small in volume and less traumatic, cystostomy is nevertheless difficult to tolerate in weakened and elderly patients, who often have concomitant diseases.

Noteworthy is drainage of the bladder by suprapubic puncture with a trocar leaving a rubber catheter. The puncture technique is simple, painless, low-traumatic and does not require special conditions. It can be performed in the dressing room or ward. Anesthesia is administered along the midline of the abdomen 2 cm above the palpable symphysis pubis, the skin is incised and a trocar is inserted from front to back and slightly downwards. The small diameter of the tube and significant contraction of the bladder with displacement lead to the bladder sliding off the drainage. The tube may be bent, salts may be deposited in it, which interferes with the flow of urine. Urinary leakage and paracystitis occur. Currently, one- and two-way trocars are produced, which are used to fix the bladder and simultaneously wash it. A detachable tube-trocar (two half-tubes up to 130 mm long and 8 mm in diameter) has been developed. When a trocar is inserted, these half-tubes are moved apart, after which a Petzer catheter is inserted. The advantages of this method are the following: the catheter itself is held in the bladder, it is elastic, its lumen has a larger diameter, which creates more favorable conditions for drainage of the bladder.

With constant and prolonged drainage of the bladder, the stretch reflex is impaired. The bladder detrains and develops irreversible changes in his intramural nervous apparatus, which is the reason for the decrease and even complete loss functional ability detrusor.

The presence of infection and prolonged unimpeded outflow of urine causes the formation of a small, wrinkled bladder, which loses the elasticity so necessary for its normal functioning. Therefore, the bladder must be constantly washed with antiseptics, periodically filled and retained in it. In 1935, Monroe and Guy proposed an automatic bladder filling and emptying device.

Ishuria (urinary retention) – pathological process associated with urinary disorders. It is often accompanied, leads to development, contributes to the emergence arterial hypertension. In most cases, acute urinary retention requires urgent surgery. But before you begin to treat ischuria, it is necessary to identify which diseases it is a symptom of. Without eliminating the cause that led to the disruption of urine outflow, the pathology cannot be cured.

How does ischuria manifest itself?

Normally, urination is painless. After this process, there is virtually no urine left in the bladder. With ischuria, the bladder fills but cannot empty. Urinary retention occurs:

1. Full. Manifests itself in acute and chronic ischuria. There is an urge to urinate, but no urine is released. All the fluid accumulates in the bladder.
2. Partial. Such ischuria is characteristic of chronic pathology. After urination, some urine remains in the bladder. This is how chronic incomplete urinary retention develops.
3. Paradoxical ischuria (is a special form of chronic urinary retention). When the bladder is full, urine is released in drops. In this form, ischuria is accompanied by urinary incontinence.

Acute urinary retention occurs suddenly. In case of accumulation large quantity urine in the bladder, patients with acute ischuria complain:

• on severe pain lower abdomen, perineum, rectum;
• painful, intense urge to urinate;
• inability to urinate.

With ischuria, the unbearable painful urge to urinate may decrease and then resume.

During an attack, patients are concerned not only with intense pain. The greatest discomfort comes from painful urge to urinate without emptying the bladder. And then the patients try to alleviate their condition by pressing on the bladder area and squatting.

Ischuria is detected not only by patient complaints. To establish a diagnosis, the following is carried out:

• examination (detect a round formation above the pubis);
• palpation (a full bladder can be felt, it is painful);
• (to detect prostate diseases);
• vaginal examination (to exclude urethra).

Sometimes long-term acute ischuria becomes chronic.

Chronic ischuria is characterized by aching pain and the presence of urination. It’s just that urine is released in a sluggish, weak stream, in small quantities. In this case, the walls of the bladder are stretched, the tone of the smooth muscles of the detrusor is disrupted. This leads to the fact that each time more urine remains in the bladder. As a result, vesicoureteral reflux develops and inflammatory kidney diseases occur.

To prevent ischuria from leading to dire consequences, it must be eliminated immediately. But the treatment depends on the underlying disease. After all, ischuria is a symptom of various pathologies.

What diseases is ischuria a symptom of?

Ischuria occurs due to a mechanical disturbance in the outflow of urine due to functional disorders of the smooth muscles of the bladder. Accordingly, urinary retention accompanies various pathologies:

• benign;
• spicy ;
• progressive cervical pregnancy;
• hematocolpometer;
• urethral leiomyoma;
• foreign bodies of the bladder, urethra;
• blood clot in the bladder;
• urethrocele;
• cancer (, urethra, prostate);
• germination of a malignant tumor into the neck of the bladder, urethra.

Ischuria may be a consequence of neurogenic bladder dysfunction:

• detrusor areflexia;
• spine surgery;
• meningomyelocele;
• psychogenic bladder dysfunction.

Sometimes ischuria is observed due to psychogenic bladder dysfunction. Often this disorder occurs in operated patients due to pain in the abdominal cavity. Ishuria in this case is due to:

• pain in the wound with tension in the muscles of the anterior abdominal wall;
• decreased detrusor tone (due to anesthesia).

Urinary retention may occur in bedridden patients. Due to the forced long horizontal position, circulation is disrupted venous blood. arise congestion in the organs and tissues of the pelvis, leading to detrusor hypotension, and in men prostate edema occurs. As a result, urinary retention develops.

Ishuria accompanies various neurogenic, urological, gynecological and oncological diseases. And sometimes urinary retention can occur due to taking medications. In women, overfilling and the inability to empty the bladder sometimes occurs during pregnancy, when the uterus compresses the neck of the bladder.

The connection between the nature of ischuria and its clinical manifestations and the underlying disease

The nature of urinary retention and the main clinical signs will help determine which disease symptom is ischuria:

The list of pathologies that cause ischuria is long. To accurately determine the cause of acute and chronic urinary retention, you need to undergo an examination. Required clinical researches the doctor will prescribe. Further treatment will depend on the nature of ischuria and the cause of this unpleasant symptom.

Where and how to treat ischuria

For effective treatment of urinary retention, it is necessary to cure the underlying pathology that caused ischuria. To stop the symptom, it is necessary to restore the flow of urine. And for this they are used various methods depending on the nature of urinary retention.

Treatment of acute ischuria

During acute attack urinary retention, the patient is sent to an emergency room surgery department, where the bladder is emptied first. To do this, it is catheterized. The procedure is contraindicated:

• at ;
• epididymo-orchitis;
• acute prostatitis;
• prostate abscess;
• urethral injury.

Sometimes, due to certain pathologies, it is not possible to install a catheter. Then the following methods are used to drain urine:

• capillary puncture of the bladder;
• open epicystostomy;
• trocar epicystostomy.

With the development of reflex ischuria, they resort to conservative method restoration of urination:

1. If the patient's condition allows, he should be seated or put on his feet. Sometimes in this position, urination is restored.
2. To prevent ischuria, an α-blocker is prescribed 2-3 days before surgery.
3. Apply a warm heating pad to the bladder area. Proserin or pilocarpine is administered subcutaneously or intramuscularly.

If these methods do not work, bladder catheterization is performed.

If the cause of ischuria is a stone in the urethra, then treatment depends on the location of the stone:

1. Stone in the prostatic urethra. It is moved into the bladder using a metal bougie. Next, contact or extracorporeal lithotripsy is performed.
2. Stone in the urethra. Remove with special forceps. Contact laser, electrohydraulic, and pneumatic stone crushing is performed during optical urethroscopy.
3. Stone in the area of ​​the scaphoid fossa. Meatotomy is indicated.

To remove a stone, it is extremely rare to resort to urethrotomy. The indication for its use is the presence of urethral stricture. Next, urethroplasty is necessary.

Chronic ischuria

For chronic urinary retention, treatment depends on the severity of ischuria. If urinary dysfunction results in:

• to disruption of urodynamics;
• the presence of a large amount of residual urine in the bladder;
• chronic renal failure.

Then it is necessary to immediately drain the bladder using a cystostomy. And only when the signs of chronic renal failure are eliminated and bladder function is restored, the factors that caused ischuria are eliminated.

ISHURIA (ischuria; Greek, ischo retain + uron urine; syn.: urischesis, retentio urinae) - urinary retention, inability to empty the bladder; a symptom of a wide variety of diseases. More common in men, less common in women and children.

The following types of I. are distinguished: 1) acute complete, occurring suddenly and accompanied by pain and the urge to urinate; 2) acute incomplete, when urine is released in drops from a full bladder (paradoxical I.); 3) chronic complete, when urination is impossible and urine is released with a catheter; 4) chronic incomplete, when the patient urinates, but the bladder does not empty completely.

Acute forms of I. are extremely painful for the patient, quickly bring him to the doctor and are therefore less dangerous than chronic forms, which often proceed unnoticed, do not attract the patient’s attention and are detected at an advanced stage, when urinary intoxication occurs. At first, I. is not accompanied by a urinary tract infection, but it soon follows, especially after catheterization. The infection aggravates the course of I., its elimination is possible only after full recovery urination.

Etiology

Acute incomplete I. is observed in diseases and damage to the nervous system (cerebral hemorrhages, fractures and gunshot wounds spine with spinal cord damage), tuberculous spondylitis, tabesa, hysteria and multiple sclerosis; can develop during severe diseases, including infectious diseases (typhoid, malaria), with inflammatory processes, eg. with peritonitis, inflammation hemorrhoids, adnexitis, with neoplasms located in the pelvis along the urethra. Acute complete I. is the main symptom of injury to the urethra or bladder. With gonorrheal and traumatic strictures of the urethra, I. is observed periodically, in attacks, which are usually associated with sexual intercourse or the introduction of a bougie. In the latter case, I. occurs several hours after bougienage due to swelling of the mucous membrane at the site of narrowing. When the urethra is blocked by a foreign body or stone, acute complete I. is possible.

I. most often occurs in men with diseases of the prostate gland (adenoma, cancer). Acute complete I. with prostate adenoma can be the first symptom of the disease, appearing suddenly, without any warning signs. In the chronic version of the disease, the patient for a long time complains of difficulty urinating (chronic incomplete 11. .

Sometimes I. develops after surgical operations or childbirth. The ethnology of this form of I. is diverse and is determined by the nature and localization of the operation: on the perineum, rectum, in the abdominal cavity, large and small pelvis, and on the genitals. Postoperative I. is also associated with the nature of pain relief, appearing more often after spinal anesthesia. The main cause of I. after childbirth is detrusor atony, which developed due to injury to the bladder during delivery, and labor pain, as well as injury to the hypogastric nerves during the passage of the fetal head through the birth canal.

Clinical manifestations

In case of acute complete urinary retention due to diseases of the prostate gland (abscess, adenoma, cancer), as well as in case of I. due to stricture or injury, patients are restless, do not find rest, experience pain in the suprapubic region with frequent strong urges, and try unsuccessfully to release urine , taking various provisions. In the suprapubic region, examination reveals a bulge associated with an overfilled bladder (Fig. 1).

With urinary retention due to c. n. With. the urge to urinate is either absent or weakly expressed; the patient is completely calm, despite significant overflow of the bladder. During the examination, one or another neurol syndrome is revealed. There may be both spastic and flaccid paresis with a corresponding increase or decrease in tendon reflexes and muscle tone, as well as a sensitivity disorder of a predominantly conductive nature. I. in diseases of the nervous system is accompanied by simultaneous difficulty in bowel movement.

Diagnosis

Complete acute and complete chronic, urinary retention is easily diagnosed. It is more difficult to identify incomplete I. It is necessary to determine the cause of the delay, since the choice of emergency care method depends on this.

Incomplete urinary retention can be recognized by the presence of a significant amount of residual urine (more than 300 ml), as determined by catheterization performed immediately after urination. Residual urine is also determined by administering radioisotope drugs, which are excreted by the kidneys and remain in the bladder along with residual urine after urination.

In all forms of hron, urinary retention, the muscular wall of the bladder hypertrophies compensatoryly, which leads to the formation of trabecularity visible during cystoscopy, and sometimes diverticulosis. In cases of atony of the bladder, atrophy of its mucous membrane and muscle layer usually develops (Fig. 2).

Differential diagnosis should be carried out with anuria (see), when there is no urge to urinate, percussion examination of the suprapubic region and catheterization in the bladder does not detect urine. Tumors in the suprapubic region may simulate a full bladder; in these cases, the issue is resolved after emptying the bladder with a catheter.

Treatment

Emergency assistance for various types I. consists of removing urine with a catheter using a suprapubic puncture or applying a suprapubic fistula (see Cystostomy). The method of emptying the bladder depends on the disease that caused I.

When treating postpartum and postoperative I., the main task is to remove urine without resorting to catheterization. Sometimes the urge to urinate is caused by the sound of water flowing from a tap; Irrigation of the external genitalia with a jet is also used warm water. Subcutaneous administration of proserin (1 ml of 0.05% solution) has a good effect. Catheterization (see) should be carried out aseptically; indicated when these remedies do not lead to a positive result. If repeated catheterization is necessary, the bladder cavity should be rinsed with a disinfectant solution ( rivanol solution 1:2000 or Furacilin solution 1:5000). At the same time, chloramphenicol, nitrofuran derivatives (furadonin, furagin, furazolidone) or negro are prescribed orally to prevent cystitis and pyelonephritis.

Prognostic value of ischuria

Chron. I. is accompanied by changes in urodynamics in the upper urinary tract, impaired renal function and can lead to the development of urosepsis.

Table “The most common causes of urinary retention, their nature, associated clinical signs and therapeutic measures”

Bibliography: Balueva L.F. Urological complications of radical operations for rectal cancer, Urol, and nephrol., No. 4, p. 51, 1976; To water E.I. New way treatment of postoperative and postpartum ischuria, Klin, med., vol. 5, No. 2, p. 117, 1927; Persianinov L. S. Operative gynecology, p. 552, M., 1976; Pytel A. Ya, and P o-gorelko I. P. Fundamentals of practical urology, p. 484, Tashkent, 1969; Epstein I. M. and Glazer Yu. Ya. Determination of residual urine by radioisotope method, Urol, and nephrol., No. 6, p. 19, 1965; G i b e r t J. et Perrin J. Urologie chirurgicale, P., 1958; Klinische Urologie, hrsg. v. G. E. Aiken u. W. Staehler, S. 281, Stuttgart, 1973; M i ch o n P. Les retentions d’urine, in the book: Traite path. Med., publ. sous la dir de E. Sergent e. a., t. 13, p. 433, P., 1923.

Y. V. Gudinsky.

Ischuria (also urinary retention) is the accumulation of urine inside the bladder as a result of the inability/inadequacy of independent urination. This dysuric pathology occurs due to decreased contractility of the bladder or narrowing of the urethra (urethra).

Ishuria must be distinguished from anuria, in which there is no urination due to renal obstruction or impaired urination and the bladder does not fill at all.

Types of ischuria

Ishuria is divided into three types:

• chronic ischuria - caused by persistent narrowing of the urethra or atony of the bladder;
• acute ischuria - can occur suddenly, against the background of a normal general condition, or develop against the background of chronic ischuria, trauma or acute illness;
• Paradoxical ischuria is a pathology in which the bladder is full, the patient is unable to urinate, and urine is spontaneously released drop by drop.
• Both chronic and acute ischuria can be either complete or incomplete. In the case of complete urination, independent urination is not possible, and in case of incomplete urination, emptying occurs with difficulty.

Causes of ishuria

Ishuria can occur due to:

• diseases and injuries of the nervous system (spinal injuries, cerebral hemorrhages);
• multiple sclerosis and hysteria;
• severe infectious diseases (for example, typhoid malaria);
• severe phimosis;
• stones in the bladder, urethra;
• adenoma, prostate cancer;
• inflammatory processes in hemorrhoids, adnexitis, peritonitis;
• injuries of the urethra, bladder;
• surgical interventions and childbirth.

Acute ischuria can appear suddenly after great mental or physical stress, as well as after drinking alcoholic beverages.

Symptoms of ischuria

In acute complete ischuria due to prostate diseases ( malignant tumors, adenoma, abscess) as well as injuries, patients are very restless and feel sharp pains in the suprapubic area with periodic strong urges, trying in vain to urinate, taking various positions. In men, pain radiates to the penis.

With ischuria against the background of diseases of the nervous system, the urge to urinate either does not appear at all or is very weakly expressed, the patient is calm, despite the pronounced overflow of his bladder. During diagnosis, a certain neurological syndrome is detected (paresis, sensitivity disorders, etc.)

Ishuria may be accompanied by the following additional symptoms:

• problems with bowel movements (constipation);
• decreased or lack of appetite;
• nausea and vomiting;
• increased body temperature;
• sleep disorders.

Diagnosis of ischuria

Complete ischuria (both acute and chronic) is diagnosed without difficulty. In cases of severe urinary retention, physical examination reveals a bulge in the suprapubic area, which is associated with bladder overflow. Percussion (tapping) can be performed, which allows you to determine the boundaries of a full bladder.

In less severe cases of ischuria, ultrasound diagnostics of the bladder and kidneys is performed. Also, incomplete urinary retention can be diagnosed in the presence of a large amount of urine (more than three hundred milliliters), which is determined through catheterization performed immediately after urination. Determination of residues can also be done by administering radioisotopes, which are quickly excreted by the kidneys and settle in the bladder along with the remaining urine after urination. In addition, the following diagnostic methods are used:

• general blood test (to determine symptoms of the inflammatory process);
• urinalysis (to detect inflammation in the urinary tract and kidneys);
• biochemical blood test (carried out to identify various abnormalities in the functioning of the kidneys);
• Ultrasound diagnostics of the prostate.

Treatment of ischuria

In case of acute ischuria, emergency care is necessary, which consists of artificial emptying of the bladder and restoration of normal urine outflow. At the prehospital stage of care medical care emptying is carried out through catheterization or puncture of the bladder in the suprapubic region.

With reflex ischuria, attempts are made to establish bowel movement reflexively (the sound of running water from a tap, irrigation of the genitals with warm water). If these methods are ineffective, medications are used. Proserin (cholinesterase inhibitor) is administered subcutaneously. Catheterization is indicated if these drugs do not produce the desired result. At the same time, funds are prescribed for oral administration: chloramphenicol, furazolidone or furadonin, as well as black to prevent pyelonephritis and cystitis.

Complications of ischuria

If untimely or improperly treated, ischuria can cause the following complications:

• infectious diseases (cystitis and pyelonephritis);
• chronic renal failure;
• the occurrence of bladder stones;
• kidney hydronephrosis;
• bladder diverticulum.

Prevention of ischuria

In order to prevent urinary retention it is necessary.