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Urinary retention can be an very painful condition with numerous causes. Test your knowledge with a couple of cases!

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Urinary retention

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Question 1

Stem 1, question 1 of 5

Munya, a 67 year old man, presents to A&E, accompanied by his husband, in urinary retention
Which of the following will not cause urinary retention by obstructing the urethra?
A
Cystocele
B
Benign prostatic hyperplasia
C
Renal calculi
D
Vaginal childbirth
E
Bladder tumour
Question 1 Explanation: 
This is an application of anatomy question. Vaginal childbirth can result in an innervation defect to the bladder and relevant sphincters and such results in retention. The all other answer options can obstruct the urethra and cause urinary retention
Question 2

Stem 1, question 2 of 5

Munya is found to be in urinary retention due to an obstruction of his urethra. Which of the following is an expected blood result due to this condition?
A
A low haemoglobin count
B
Decreased glomerular filtration rate
C
Increased glomerular filtration rate
D
Elevated bilirubin
E
A high haemoglobin count
Question 2 Explanation: 
An obstruction of the urethra will cause back pressure to the kidney by preventing urinary flow. This can result in decreased renal blood flow and so a decreased glomerular filtration rate and the up-regulation of the renin-angiotensin system.
Question 3

Stem 2, question 3 of 5

Munya is diagnosed with benign prostatic hyperplasia (BPH), which of the following is not a voiding symptom?
A
Nocturia
B
Weak stream
C
Hesitancy
D
Incomplete emptying
E
Post-void dribbling
Question 3 Explanation: 
BPH presents with two key categories of symptoms: storage and voiding symptoms. Nocturia is a storage symptom whereas the others are voiding symptoms such as weak stream, hesitancy, intermittency, straining, incomplete emptying and post-void dribbling.
Question 4

Stem 1, question 4 of 5

What conservative management is available for benign prostatic hyperplasia?
A
Pelvic floor exercises
B
Monitoring and observation
C
Treatment of diarrhoea
D
Bladder re-training
E
Pessary
Question 4 Explanation: 
The goal with BPH is to improve lower urinary tract symptoms to improve quality of life. Conservative treatment resolves around behavioural training such as limiting fluid, bladder re-training and treatment of any constipation.
Question 5

Stem 1, question 5 of 5

Munya asks if there is any medications he can take to treat his BPH. Which of the following is not a medication for BPH?
A
Doxazosin
B
Tamsulosin
C
Finasteride
D
Ropinirole
E
Sildenafil
Question 5 Explanation: 
Ropinirole is a dopaminergic drug used to treat Parkinson's disease. Doxazosin and tamsulosin are both alpha blockers, finasteride is a 5-alpha-reductase inhibitor and sildenafil is are phospodisterase 5 inhibitor and can all be used to treat BPH.
Question 6

Stem 2, question 1 of 3

Jing, an 87 year old female with Alzheimer's disease, presents with recurrent episodes of urinary retention to her GP accompanied by her husband Ronny.
How does Alzheimer's disease cause urinary retention?
A
Loss of dopamine and resulting interruption of signals from the brain mean the bladder does not receive the signal to expel urine
B
Increasing age means the detrusor muscle is weakened
C
There is a narrowing or closure of the urethra
D
The detrusor muscle fails to function properly due to interruption of higher brain signals leading to urinary retention and obstructive uropathy
E
The bladder bulges into the vagina and results in urinary retention
Question 6 Explanation: 
Alzheimer's disease is a progressive neurodegenerative form of Dementia and this will lead to a innveration problem causing urinary retention.
Question 7

Stem 2, question 2 of 3

Jing has previously had a cystocele, which of the following is not a risk factor for cystocele formation?
A
Endometriosis
B
Repetitive straining for bowel movements
C
Heavy lifting
D
Childbirth
E
Being overweight
Question 7 Explanation: 
A cystocele is a bulging of the bladder into the vagina and occurs then the muscles are supportive tissue between the bladder and vagina fail, thus the risk factors are all largely based on putting extra strain on tissues. Rarely, a large cystocele can also cause urinary retention.
Question 8

Stem 2, question 3 of 3

Ronny asks what he can do to support Jing and help prevent her going into urinary retention again, what would be the most appropriate advice to give him?
A
Encourage Jing to wear pads
B
Give Ronny a leaflet on a permeant catherisation and ask him to discuss it with Jing
C
Limit Jing's fluid intake
D
Ask Jing at regular intervals if she needs to urinate
E
Teach Jing to do pelvic floor exercises
Question 8 Explanation: 
This is an application question of the management of urinary retention in someone with Alzheimer's disease and an understanding of the role of a carer in this situation. Asking Jing at regular intervals if she needs to urinate if a simple solution to maintain her dignity and a reminder may be all she needs. The other answer options are not appropriate in this case.
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