Urological Emergencies in Clinical Practice стр.18

So, a trial of an alpha blocker is reasonable, but a substantial number of men with spontaenous acute retention of urine will end up going back into retention and will therefore eventually come under the care of a urologist for TURP.

RETENTION IN PATIENTS WITH A CATHETERISABLE STOMA

An increasing number of patients have undergone reconstructive surgery involving the formation of a catheterisable stoma, such as a Mitrofanoff stoma.

Patients with a Mitrofanoff catheterisable stoma are sometimes unable to pass a catheter into their stoma. This not infrequently occurs after spinal or other surgery. The spinal surgery may change the 'angle' of the stoma or their bladder may become overfull in the post-operative period which again may distort the stoma to the extent that it is difficult to pass a catheter. In this situation, attempting to pass the catheter yourself, using plenty of lubrication, is reasonable. If you fail, try to pass a floppy guidewire through the stoma (preferably under radiological control if this is available). This may pass into the bladder where the catheter will not. A catheter, with the tip cut off, can then be passed over the guidewire and into the bladder. If this fails, pass a suprapubic catheter, empty the bladder, and then usually the patient will be able to pass their catheter without any problems.

References

Abrams P, Dunn M, George N. Urodynamic findings in chronic retention of urine and their relevance to results of surgery. BMJ 1978; 2:1258-1260.

Djavan B, Madersbacher S, Klingler C, Marberger M. Urodynamic assessment of patients with acute urinary retention: is treatment failure after prostatectomy predictable. J Urol 1997;158:1829-1833.

Fowler C. Urinary retention in women. Br J Urol Int 2003;91:463-468.

George NJR, O'Reilly PH, Barnard RJ, Blacklock NJ. High pressure chronic retention. BMJ 1983;286:1780-1783

Hastie KJ, Dickinson AJ, Ahmad R, Moisey CU. Acute retention of urine: is trial without catheter justified? J R Coll Surg Edinb 1990; 35:225-227.


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