Acute Retention of urine

10. Retention Acute

      This is a sudden onset of stoppage of passage of urine and there is pain in the hypo-chondrium due to a distended bladder due blader outflow obstruction (BOO)

      The cause can be

      -     Being prostatie Hypertrophy

      -     Bladder neck obstruction

      -     Urethral stricture

      -     Phimosis

      -     Urethritis

      -     Rupture urethira  }____ In trauma cases

      -     Cord injury          }

      On examination the patient is in distress because of pain and the bladder is palpablc and tender. On history taking and examination you can also identify the cause

10.1 Treatment

      In most cases the patient will need relief with a fine urethral catheter and investigation of the cause and treatment related to the cause.

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Urinary Bladder cancer

CARCINOMA OF THE BLADDER

      Bladder malignancies are transitional cell tumours and, originate, from the transitional cells that line the bladder. Squamous cell carcinoma accounts for approximately 6 to 8 percent, only 2% being adenocarcinomas.

9.1 Clinical Presentation

      Haematuria occurs in 75% of all patients.

      Patients may have an associated urinary tract infection.

      Bladder irritability is a presenting symptom in 30% of patients.

Fig 26.4

      Diagnosis of transitional cell carcinoma can be made by urinary cytologic studies and further confirmed by cystoscopic examination and biopsy of the suspected area.

9.2 Treatment

      Tumours that have not invaded, may be controlled by either transurethral resection of fulguration. Once the tumour penetrates the muscle wall, there is a 30% mortality rate. Disease that penetrates into the muscle of the bladder is best managed by either partial or total removal of the bladder.

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Urinary Bladder conditions 3 stones

8. VESICAL CALCULUS

      This condition is still met within India among the poor and malnutrioned population (Vitamin A defeciency)

*     Primary stones occur in sterile urine

*     Secondary stones occur in presence of infection and

      obstruction

*     Obstruction to outlog can also cause stones.

8.1 SYMPTOMS

1.    Frequency

2.    Pain (Strangury) on pressing

3.    Haematuria

4.    Stoppage of stream in micturating

5.    Investigation

8.2 Treatment

1.    Removed Stone (open) Cystolithotomy

2.    Litholapaxy removal of stone by crushing with lithotrite

Fig.26.3

Gystostomy Cystolithotomy

This is required to relieve acute retention in impassable strictures also in cases of stone in the bladder to remove the stone.

-        A low transverse suprapubic incision

-        The rectus muscle on both side is mobilized aand retracted

-        Bladder identified

-        Peritoneum reflected off the bladder by blunt dissection

-        Longitudinal incision into the bladder

-        Bladder finger explored

-        Stone removed

-        Bladder closed around a catheter

-        Retro-public space drained

-        Wound closed

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Urinary blader conditionss 2 fistulas

6. FISTULA

      Vesico-enteric fistulas are as a result of inflamatory disease of the colon (diverticalitis) or crohn’s disease. Carcinoma of the colon or bladder can also be responsible.

6.1 Pnematurea (passing air) occurs in 60% of cases.

6.2 Fecalurea occurs in 20-50% of cases. Diagnosis is established radiologic contrast (IVP or Ba) will be required.

7. Vesico-Vaginal Fistula

      This occurs as a result of injury sustained during prolonged unattended labour. Injury can also occur following urolgic or gynaecologic procedures, Fistula can also occur following pelvic trauma malignancy or radiation. Surgical repair should be attempted in all cases.

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