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the patient unable to pass urine (anuria)


initial ED approach

  • contraindications to inserting IDC by ED staff
    • recent urologic surgery (eg, radical prostatectomy or urethral reconstruction)
    • urethral stricture disease
    • suspected urethral trauma
    • acute bacterial prostatitis (relative C/I)
  • ask patient to void
  • if unable to void, assess bladder volume ASAP:
    • clinically
      • bladder is percussible when it contains > 150mL urine and may be palpable when > 200mL
    • bladder scanner
      • may give false positive results, eg. ascites
    • calculate volume using an ED ultrasound machine
      • US probe placed 3cm above PS in the midline
      • image bladder in sagittal and transverse planes, taking measurements of width of transverse image (W), AP depth of transverse image (D1) and superior-inferior length of sagiital image (D2) (all in cm)
      • calculated volume in mL = W x D1 x D2 x 0.52
      • volume percent error rate when performed by nurses ~9% (cf 18% when using a bladder scanner 1) )
      • allows visual detection of ascites as a differential to a positive bladder scan
  • if bladder scan indicates a large volume (eg > 300mL after failing to void)
    • if patient still unable to void, then, if no C/I, insert IDC (usually 14-18F catheter in adults, but if frank haematuria with clots, use a 3-way catheter to allow bladder washouts)
      • record volume drained in 1st 10-15minutes
      • if > 400mL, leave IDC in place and Mx as per acute urinary retention
      • if draining urine but < 200mL, it is not acute retention and IDC should probably be removed unless other indication to keep it in situ
      • if 200-400mL drained, consider removing IDC depending upon clinical scenario
      • if minimal urine from IDC:
        • check with USS to exclude false positive bladder scan scenarios such as ascites
      • if unable to pass an IDC:
        • consider trying with a smaller catheter, eg. 10-12F
        • call a senior doctor to consider trying
      • if C/I to IDC or still unable to pass an IDC
        • call urology reg for advice
        • may need to have an urgent suprapubic catheter inserted, preferably with US guidance
  • if empty bladder then consider pre-renal and renal causes:
anuria.txt · Last modified: 2016/08/10 18:12 (external edit)