Before starting treating urinary retention, we need to realize and accept that urinary retention is the very ending point of bladder overwork and exhaustion with eventual inability to empty, which can be categorized into two groups as follows: 1. Chronic urinary retention (uro-retention) unfortunately occurred as an unfortunate endpoint of personal and professional ignorance in recognizing the slowness and creepiness of LUTS as described on the page of Why do the public and doctors overlook LUTS until reaching urinary retention - even irreversible bladder damage? .
2. Acute urinary retention (uro-retention) is usually caused by some identifiable precipitating factors like the conditions after spinal anesthesia or general anesthesia, after major pelvic surgery for bladder, colon, rectum, uterus, etc., after spinal cord injury or surgery, in mandatory supine position, with pain with or without pain medication, after taking medications with adrenergic or anticholinergic effects like oxybutynin, pseudoephdrine, antihistamine, etc.
Note: The situation between chronic and acute uro-retention may be recognized as subacute uro-retention since every life event always displays on its pattern of full spectrum and doctors just see the patients at the certain point or moment of such full spectrum. Then, let us picture what the affected men may have to do, that is, to pee all the time to push a small amount of the spilled-over urine, which is called pending urinary retention, and eventually to constantly leak urine, that is, overflow urinary incontinence, for which they wear diapers (depends or pull-up) so to avoid wetting their underwears or pants. Of course, this condition is not what we want and should avoid it like escaping from a plague. Reaching this very endpoint of LUTS, what and how can we expect and make the bladder able to recover to resume its ability to store and empty urine? Known to us with common sense, If wishing to have a good outcome from medical care, medical professionals have to be able to decide when and how to make right decision to proceed with right action after mulling over the balance between medical necessity and professional possibility at every step along the course of delivering medical care. With these in mind and common sense permits and prevails, I have conjectured the following two-step formula to take: Step 1 is to protect the said damaged bladder from further unwanted damage by recurrent over-distention. How? Three options: - CISC: With clean intermittent self-catheterization (CISC) or intermittent catheterization by the willing and able caretakers who may be spouse or any family member or attending nursing staff, or - Indwelling urethral catheter for constant catheter drainage by inserting catheter manually through the urethra or - Indwelling suprapubic tube established by surgically inserting catheter through suprapubic area into the bladder as called suprapubic cystoscopy. If CISC is taken, always keep the urine inside the bladder less than 15 oz or 450 cc at any given time including what the patient may void plus the residual urine right after spontaneous voiding (if he could). If constant catheter drainage is applied, two key points for its good care are mandatory; they are: 1. always keep the suprapubic tube properly taped or fixed so not to have undue traction onto the opening to prevent incidental catheter pulling-out or bladder spasm as well as to avoid unwanted catheter obstruction and bladder overdistention by kinking or twisting, which may lead to septic symptoms from forcing bacteria and its toxin into blood stream, and 2. always keep the drainage back below the level of urinary bladder so to avoid inducing unwanted bladder distention and potential spasm.
Step 2 is decide when to do surgery if urological intervention is necessary. Although many patients may experience some recovery in bladder function after the care with the actions in Step 1 and become able to urinate by themselves, they should be still under a close watch so to avoid c proceeding to chronic urinary retention because the patients in acute retention, more or less, have some of the unnoticed underlying factors which are common as we age. If not able to resume spontaneous bladder voiding with "reasonable' stable low postvoid residual urine, surgical intervention is needed.
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