Urinary Retention In Men

WHAT YOU SHOULD KNOW:

• Urinary (UR-in-er-ee) retention (re-TEN-shun) is a condition when urine is not completely emptied from the bladder. Urinary retention usually occurs as men get older. Obstruction (blockage) of urinary flow may keep urine from leaving the body and cause a build up of urine in the bladder. An obstruction may include a stricture (narrowing) of a tube, such as the urethra, a tumor, or a bladder stone. Foreign bodies (things that are not normally found in the urinary system) or benign prostatic hyperplasia (enlarged prostate) may cause an obstruction. Bladder diverticula (pockets) may also keep the bladder from fully emptying. Damage to nerves going to and from the bladder, certain medicines, drinking too much fluid, and infections may also cause urinary retention. Urinary retention may be acute (sudden) or chronic (long-standing). Acute urinary retention occurs when there is a sudden inability to pass urine. In chronic urinary retention, there is always some urine left in the bladder as it never completely empties.
  
  
• The urinary system is made up of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs in the back of the abdomen (stomach) on both sides of the spine. They filter the blood to remove waste products and make urine. The urine flows from the kidneys down through tubes called ureters. From the ureters, the urine goes down and is stored for a short time in the bladder. Urine passes out of the body through another tube, called the urethra. In men, the bladder lies just above a walnut-sized gland called the prostate. The prostate gland wraps around the neck of the bladder and the urethra.
  
  
• Signs and symptoms may include trouble passing urine or not being able to pass urine at all. You may also have pinkish to reddish-colored urine or abdominal (stomach) pain. A digital rectal exam (DRE) may be able to determine if you have an enlarged prostate. You may also need blood or urine tests, a kidney scan or ultrasound, cystourethrogram, and urine flow tests. A computerized tomography (CT) scan and kidney, ureter, bladder (KUB) x-rays may also be done. Treatment may include medicines to ease your symptoms, placing a catheter or shunt (hollow tube), and surgery. With treatment, such as medicine and surgery, further problems may be prevented and your quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Treatment for urinary retention may cause unwanted side effects. Some medicines may cause dizziness, fast heartbeat, headache, weakness, high blood pressure, or sexual problems. Your prostate or other parts of the urinary tract, blood vessels, or nerves may get injured during surgery. You may have trouble breathing. You may also have an infection or too much bleeding after surgery. Even after having surgery, there remains a chance that you will have another episode of urinary retention.
  
  
• If left untreated, you may not be able to pass urine and may get infections. These may cause further problems and may cause damage to your urinary tract, especially to your kidneys. If waste products are not removed, you may get sepsis (blood infection) or your kidneys may fail (stop working). This may lead to more serious and often life-threatening problems, such as heart, liver, or brain damage. Ask your caregiver if you are worried or have questions about your condition, medicine, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may need any of the following:

• 5-alpha-reductase inhibitors: These medicines decrease the size of a large prostate gland by stopping the action of 5-alpha reductase. 5-alpha reductase is a protein that makes the prostate gland grow bigger.
  
  
• Alpha blockers: These medicines relax the muscles in your prostate and bladder and may help you urinate more easily.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Hormone therapy: Hormones (such as testosterone) may cause some cancer cells to grow. Medicine or surgery may be needed to block the testosterone and slow a growing tumor. Sometimes both medicine and surgery are needed. If you need surgery, your testicles may be removed to stop the testosterone.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Tests:

You may need any of the following:

• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Blood or urine tests: A sample of your blood or urine is collected and sent to a lab for tests. Your caregiver may suggest a special blood test to check for the prostate-specific antigen (PSA). PSA blood levels may be increased in prostate cancer.
  
  
• Imaging tests:
  
  
  • Computerized tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your prostate, kidneys, ureters, and bladder. Before taking the pictures, you may be given dye through an IV in your vein. The dye may help your caregiver to better see if there are any problems. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp) as may also be allergic to this dye.
    
    
  • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.
    
    
  • Cystourethrogram: A dye is injected and x-rays are taken while you pass urine. The dye makes an outline of your bladder and urethra. This shows the changes that occur in your urinary tract while urinating.
    
    
  • IVP: This is also called an intravenous pyelogram. An IVP is an x-ray of the kidneys, bladder, and ureters (tubes that carry urine). Dye is put into your IV, which makes these organs show up better in x-ray pictures. You may need to have more than one x-ray over short periods of time during your IVP. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or other medicines.
    
    
  • KUB x-ray: An x-ray machine takes pictures of your kidneys (K), ureters (U), and bladder (B). The ureters are tiny tubes that carry urine from your kidneys to your bladder. The bladder is where the urine is stored before leaving your body. Caregivers use these pictures to check for problems with your intestines , kidneys, or abdomen.
    
    
  • Magnetic resonance imaging: This test is also called an MRI. During an MRI, computerized pictures may be taken of different areas, depending on where your caregiver thinks the problem is. Pictures may be taken of your abdomen, pelvis (hips), brain, or spinal cord. Caregivers use these pictures to look for problems in your bladder, prostate, rectum (rear end), pelvic organs, brain, or spinal cord. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Ultrasound: Sound waves are used to show pictures of the inside of your abdomen. A small closed tube with lotion on it is gently moved around on your abdomen. The handle may also be placed in your rectum. Pictures of your bladder, prostate, rectum, or other organs are seen on a TV-like screen.
  
  
• Other tests:
  
  
  • Prostate biopsy: A sample of your prostate or its fluid may be taken and sent to the lab for tests.
    
    
  • Urine flow test: This test checks if the muscles of your bladder are working properly. It also measures how much urine your bladder can hold. This test can also tell whether your bladder fills and empties in a normal way.

Treatment options:

You may need any of the following:

• Surgery: Sometimes, caregivers may do surgery to remove a blockage so urine can drain from the bladder. A hollow tube, such as a shunt or stent, may also be placed to help widen a narrowed part of your urinary tract. If you have an enlarged prostate, your caregiver may also need to remove your prostate.
  
  
• Other procedures: The prostate may be made smaller by using a special ultrasound, transurethral needle ablation (TUNA), or microwave heat treatment. You may also have a laser procedure, called interstitial laser coagulation (ILC), to remove the prostate. Ask your caregiver about these different treatment options for urinary retention.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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