Every acute retention of urine demands immediate relief. It must be relieved not only on account of pain and discomfort but more especially to avoid damage to the bladder or urethra and the evil effects of sepsis. This rule applies equally to cases due to temporary insufficiency of the bladder musculature and those due to urethral obstructions, which may assume various forms: spasm of the urethra, enlargement of the prostate gland, or stricture. In every case before instituting measures for relief, it is wise to make minute inquiry into the patient's history with respect to this function. At least one should be suspicious of the presence of stricture and on his guard.
Catheterization is the first measure of relief to be tried in actual retention if opium and a prolonged warm bath are not practical. A cylindrical metal case capped at one end is most convenient for keeping and carrying these instruments, which include soft-rubber catheters of various sizes, flexible bougies with olivary and ve tips, gum catheters with single and double elbows or armel with stylets, filiform bougies (Pigs, 450, 451, 452, 453; 454). Sterilization of these instruments may be a problem except for the rubber catheters, which may without injury be disinfected by boiling. The other instruments are best sterilized by formaldehyde vapor and should be prepared before leaving the office and exrriel wrapped in sterile cloths.
<Callout type="important" title="Sterilization is Critical">All equipment must be thoroughly sterilized to prevent infection during catheterization.</Callout>
Position of Patient.—The patient should lie upon a table high enough that the operator does not need to stoop. The pelvis should be elevated and the thighs flexed and abducted. Begin by thoroughly cleansing the field; cleanse the penis, the foreskin on both sides, the glands and the meatus, wiping each part with a separate compress. If possible, irrigate the urethra with boric acid or normal salt solution.
<Callout type="risk" title="Risk of Stricture">If all catheterization efforts fail due to stricture, resort must be had to filiform bougies which may be bent into various shapes and kept so by a thick collodion coating.</Callout>
Permanent drainage is indicated from the first if distance precludes two or three daily visits. If the urethra has been lacerated by rough attempts at catheterization, and if to the symptoms of retention are added those of sepsis and the signs of beginning infiltration, it is imperative to establish permanent drainage of the bladder.
CYSTOTOMY. Permanent drainage through the suprapubic puncture is often alone available, though by no means ideal. Whenever possible, the bladder is to be opened formally and the drainage established by that means, nor is the operation beyond the skill of the general practitioner.
Key Takeaways
- Immediate relief for acute urinary retention is critical to prevent damage and infection.
- Catheterization should be attempted first, using sterilized equipment.
- Suprapubic puncture may be necessary if catheterization fails due to stricture or severe obstruction.
Practical Tips
- Always use sterile equipment during catheterization to avoid introducing infections.
- Prepare for potential complications such as urethral laceration and sepsis.
- Learn the proper positioning of the patient to facilitate easier access.
Warnings & Risks
- Failure to relieve acute urinary retention can lead to severe bladder damage or infection.
- Improper catheterization techniques may cause further injury, including stricture formation.
Modern Application
While modern medicine has advanced significantly since 1915, the principles of immediate relief for acute urinary retention remain crucial. The historical emphasis on sterilization and proper technique is still relevant today, though modern materials and methods have improved safety and efficacy.
Frequently Asked Questions
Q: What are the primary causes of urethral obstruction mentioned in this chapter?
The chapter mentions three main causes: spasm of the urethra, enlargement of the prostate gland, or stricture.
Q: Why is sterilization so important during catheterization procedures?
Sterilization is critical to prevent infection and ensure that no pathogens are introduced into the urinary tract during the procedure.
Q: What should be done if all attempts at catheterization fail due to stricture?
If all catheterization efforts fail, filiform bougies may be used which can be bent into various shapes and kept so by a thick collodion coating.