Difficulty urinating and urinary retention

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Difficulties in urinating are caused by increased abdominal pressure during urination. When the condition is severe, there is urine in the bladder and the urinary retention cannot be discharged. Difficulties in urination can be divided into functional and obstructive categories.

Cause

Cause

Obstructive dysuria

(1) bladder neck lesions: the neck is blocked by stones, tumors, blood clots, foreign bodies, or uterine fibroids, ovarian cysts, late pregnancy compression; due to bladder neck inflammation, stenosis, etc. are all listed.

(2) posterior urethral disease: due to prostatic hypertrophy, prostate cancer, acute inflammation of the prostate, hemorrhage, empyema, fibrosis after compression of the urethra; posterior urethra itself inflammation, edema, stones, tumors, foreign bodies and so on.

(3) anterior urethral disease: seen in the anterior urethral stricture, stones, tumors, foreign bodies, or congenital malformations such as urethral valgus, penile foreskin incarceration, abnormal penile erection.

2. Functional dysuria: seen in spinal cord lesions, organic spine caused by recessive spina bifida; also seen in diabetic neurogenic bladder, caused by autonomic nerve damage caused by diabetes. Patients with neurosis can have difficulty urinating in public toilets. Surgical birth injury in the perineal area can cause urinary sphincter spasm caused by urinary dysfunction.

Examine

an examination

Related inspection

Bladder detrusor function test bladder ultrasound examination prostate examination urine routine 12 hours urine sediment count

History

Should pay attention to the lower abdomen, perineal area colic history, in order to understand the presence or absence of stones; to ask the speed and course of dysuria, prostatic disease slow onset, long course, and then urethral hemorrhage, abscess speed is short; understand menstruation and pregnancy In order to determine the gynecological and obstetric conditions caused by dysuria; to ask about the history of diabetes, history of spinal trauma; to ask the history of neuropsychiatric diseases.

2. Physical examination

The anal digital examination determines the size, texture, surface smoothness, tenderness, and tumor of the prostate. Check the filling of the lower abdomen to understand the extent of urinary retention. Examination of the foreskin phimosis and penile urethral fissure examination can help to clear the difficulty of urinating caused by penile disease. A neurological examination, a spinal examination, helps the nervous system to diagnose a dysuria.

3. Laboratory inspection

Regular examination of prostatic fluid is important for the diagnosis of prostatitis. Blood sugar and urine tests can confirm diabetes. Renal function tests should be performed for long periods of urinary retention.

4. Cystoscopy

Narrow neck and stones in the bladder. Tumor diagnosis helps.

5. X-ray inspection

It is helpful for the discovery of recessive spina bifida and spinal trauma. MRI examination can not only find spinal lesions, but also detect spinal cord damage, which is the best way to diagnose spinal lesions.

6. Ultrasound examination for the diagnosis of prostate disease, can also determine the urine retention of the bladder.

Diagnosis

Differential diagnosis

Poor urination: Under normal circumstances, there is urine in the bladder, which will be smoothly discharged through the bladder "opening" and urethra, but some people are very uncomfortable in urinating, not very laborious when urinating, or very urinating Fine, the urinary tract is also very close, some people can not be discharged even in the urinal for a long time, in serious cases can not develop urine, a large amount of urine "hoarding" in the bladder, become urinary retention, the patient is very painful, Obviously, the main cause of poor urination is due to obstruction on the urinary tract or lack of contraction of the bladder.

Interrupted urine flow refers to a sudden interruption of urine flow during urination, sometimes accompanied by severe pain in the head of the penis. The most common cause is that patients with benign prostatic hyperplasia must increase their abdominal muscles to drain their urine. In the late stage of the disease, the urine can not be drained at one time, and it takes a breath to continue to urinate, which is manifested as interruption of the urine flow. Patients with bladder stones, bladder tumors, bladder foreign bodies, ureteral cysts and other diseases during the urination process, stones, tumors or ureteral cysts, foreign bodies, etc. can continue to urinate after moving with the urine flow. Hematuria with poor urination, laborious and urinary drip, in elderly men are mostly prostatic hypertrophy, in middle-aged men should consider urethral stricture, urethral stones or bladder tumors.