URINARY RETENTION
i c a l l y i m p r e g n a t e d s q u a r e s o n t h e s t i c k
c h a n g e
c o l o u r
i n t h e p r e s e n c e
o f t e s t
s u b s t a n c e s . T h e i n t e n s i t y o f t h e c o l o u r
c h a n g e s h o w s t h e a m o u n t o f t h e s u b -
s t a n c e p r e s e n t i n t h e u r i n e .
U r i n a l y s i s c a n b e u s e d t o c h e c k k i d -
n e y
f u n c t i o n a n d t o
d i a g n o s e u r i n a r y
t r a c t
i n f e c t i o n s
a n d
d i s o r d e r s
s u c h
a s
d ia b e t e s m e llit u s .
U r i n a l y s i s i s a l s o u s e d
i n
p r e g n a n c y te sts.
u rin a ry d iv e rs io n
A n y
s u r g i c a l
p r o c e d u r e
( t e m p o r a r y
o r
p e r m a n e n t )
t h a t
e n a b l e s u r i n e
t o
f l o w
w h e n t h e o u t l e t o f t h e
u rin a ry tra ct,
v i a
t h e b l a d d e r a n d u r e t h r a , i s o b s t r u c t e d o r
c a n n o t b e u s e d , o r t h e b l a d d e r h a s b e e n
s u r g i c a l l y r e m o v e d .
TEMPORARY DIVERSION
T e m p o r a r y
u r i n a r y
d i v e r s i o n
m a y
b e
n e c e s s a r y w h e n t h e p a s s a g e o f u r i n e i s
b l o c k e d
b y
p ro s ta te g la n d
e n l a r g e m e n t
o r
b y
u re th ra l s tric t u re
( n a r r o w i n g
o f
t h e u r e t h r a ) . A t u b e i s p a s s e d i n t o t h e
b l a d d e r
t h r o u g h
a n
o p e n i n g
i n
t h e
a b d o m e n
( s e e
c a th e te riz a tio n , u rin a ry ).
T e m p o r a r y
d i v e r s i o n
i s
a l s o
r e q u i r e d
a f t e r s o m e
u r i n a r y t r a c t
o p e r a t i o n s ;
a
t u b e i s i n t r o d u c e d i n t o t h e k i d n e y a n d
b r o u g h t t o t h e a b d o m i n a l s u r f a c e .
PERMANENT DIVERSION
P e r m a n e n t u r i n a r y d i v e r s i o n i s n e e d e d
w h e n
t h e
b l a d d e r
h a s
b e e n
s u r g i c a l l y
r e m o v e d ;
w h e n
n e u r o l o g i c a l
b l a d d e r
c o n t r o l
i s
s e v e r e l y
d i s t u r b e d ,
s u c h
a s
a f t e r s e v e r e s p i n a l i n j u r y ; o r i f t h e r e i s
a n
i r r e p a r a b l e
f is tu la
( a b n o r m a l
o p e n -
i n g )
b e t w e e n
a
w o m
a n ’s
b l a d d e r
o r
u r e t h r a a n d h e r v a g i n a .
A s e c t i o n o f t h e
ile u m
( t h e l o w e r p a r t
o f t h e
s m a l l
i n t e s t i n e )
i s
r e m o v e d t o
c r e a t e a s u b s t i t u t e b l a d d e r , i n t o o n e e n d
o f
w h i c h
t h e
s u r g e o n
i m p l a n t s
t h e
u r e t e r s . T h e o t h e r e n d o f t h e s u b s t i t u t e
b l a d d e r i s t h e n b r o u g h t o u t t h r o u g h a n
i n c i s i o n
i n
t h e
a b d o m i n a l
w a l l .
T h e
p a t i e n t w e a r s a b a g a t t a c h e d t o t h e s k i n
t o c o l l e c t u r i n e .
u rin a ry in c o n tin e n c e
S e e
in c o n t in e n c e , u rin a ry .
u rin a ry re te n tio n
I n a b i l i t y t o e m p t y t h e
b la d d e r
o r d i f f i -
c u l t y
i n
d o i n g
s o .
U r i n a r y
r e t e n t i o n
m a y b e c o m p l e t e ( i n w h i c h u r i n e c a n -
n o t
b e
p a s s e d
v o l u n t a r i l y
a t
a l l )
o r
i n c o m p l e t e
( i n w h i c h t h e b l a d d e r f a i l s
t o e m p t y c o m p l e t e l y ) .
CAUSES
I n
m a l e s ,
c a u s e s
o f u r i n a r y
r e t e n t i o n
i n c l u d e
p h im o s is
( t i g h t f o r e s k i n ) ,
u re th -
ra l s tric t u re
( n a r r o w i n g o f t h e u r e t h r a ) ,
p ro s ta t it is
( i n f l a m m a t i o n o f t h e p r o s t a t e
g l a n d ) , a s t o n e i n t h e b l a d d e r ( s e e
c a lc u -
lu s, u r in a r y tra ct
) ,
a n d
e n l a r g e m e n t
o r
t u m o u r
o f t h e
p r o s t a t e
( s e e
p ro sta te ,
e n la rg e d ; p ro sta te , c a n c e r o f ).
I n f e m a l e s ,
c a u s e s i n c l u d e p r e s s u r e o n t h e u r e t h r a
f r o m u t e r i n e
f ib r o id s
o r f r o m a g r o w i n g
fe tu s
i n
t h e
u t e r u s .
I n
e i t h e r
s e x ,
t h e
c a u s e m a y b e a b l a d d e r t u m o u r .
U r i n a r y r e t e n t i o n m a y a l s o b e c a u s e d
b y a d e f e c t i v e f u n c t i o n i n g o f t h e n e r v e
p a t h w a y s t h a t s u p p l y t h e b l a d d e r a s a
r e s u l t o f g e n e r a l o r s p i n a l
a n a e s t h e s ia
,
o f
d r u g s
a f f e c t i n g
t h e
b l a d d e r ,
o f
s u r g e r y , o f i n j u r y t o t h e n e r v e s ,
o r o f
d i s e a s e o f t h e s p i n a l c o r d .
SYMPTOMS
C o m p l e t e
u r i n a r y
r e t e n t i o n
c a u s e s
d i s c o m
f o r t a n d l o w e r a b d o m i n a l p a i n
( e x c e p t w h e n t h e
n e r v e p a t h w a y s a r e
d e f e c t i v e ) . T h e f u l l b l a d d e r c a n b e f e l t
a b o v e
t h e
p u b i c
b o n e .
C h r o n i c
o r
p a r t i a l u r i n a r y r e t e n t i o n , h o w e v e r , m a y
n o t
c a u s e
p r o b l e m s ,
a n d t h e
a f f e c t e d
i n d i v i d u a l m a y b e u n a w a r e o f t h e c o n -
d i t i o n .
U r i n a r y
r e t e n t i o n
c a n
l e a d
t o
k i d n e y
d a m a g e
a n d ,
o f t e n ,
a
u r i n a r y
t r a c t i n f e c t i o n .
TREATMENT
T h e c o n d i t i o n i s t r e a t e d b y c a t h e t e r i z a -
t i o n
( s e e
c a th e te riz a tio n , u r in a r y ).
T h e
c a u s e i s t h e n i n v e s t i g a t e d . O b s t r u c t i o n
c a n u s u a l l y b e t r e a t e d ; i f n e r v e d a m a g e
i s t h e c a u s e , p e r m a n e n t o r i n t e r m i t t e n t
c a t h e t e r i z a t i o n i s s o m e t i m
e s n e c e s s a r y .
URINARY DIVERSION USING ILEAL CONDUIT
This is one of the standard operations
that can be performed when the
bladder has to be removed. A midline
incision in the abdomen is used; before
making the incision, the surgeon
creates an opening through the
abdominal wall in a good position for
later attachment of the collecting bag.
1
A short length is cut out of the ileum
(the lower part of the small intestine),
retaining the mesentery (supporting folds
oftissue) and the essential blood vessels
that supply the freed section.
T7
XL/
fi
- 7
7
u .
y
; /
<*
B
v
y t
\
T
f
.
A
J
Ü
J Ï
-
'
'
// ■
v
M
I f
\
v
:
w
2
The cut ends ofthe intestine are rejoined.
One end ofthe freed length of intestine is
closed, and the other end is temporarily
clamped. The bladder is removed.
3
The ureters are now implanted into the
isolated length ofileum. The open end
ofthis segment is brought through the
abdominal wall and stitched in place.
. Umbilicus
. Stoma
.
Collecting bag
'v .y
4
A disposable collecting bag for receiving
the patient’s urine is attached with
adhesive around the new stoma (opening)
in the wall ofthe abdomen.
U
773
previous page 772 BMA A Z Family Medical Encyclopedia   2004 read online next page 774 BMA A Z Family Medical Encyclopedia   2004 read online Home Toggle text on/off