Ischuria (also urinary retention)- this is the accumulation of urine inside the bladder as a result of the impossibility / insufficiency of independent urination. This dysuric pathology occurs due to a decrease in the contractility of the bladder or narrowing of the urethra (urethra).

Ischuria must be distinguished from anuria, in which urination does not occur due to obstruction of the kidneys or impaired urination and the bladder does not fill at all.

Types of ischuria

Ischuria is divided into three types:

• chronic ischuria - caused by persistent narrowing of the urethra or atony of the bladder;
• acute ischuria - can come on suddenly, against the background of a normal general condition, or develop against the background of chronic ischuria, injuries or acute illnesses;
• paradoxical ischuria - a pathology in which the bladder is full, the patient is not able to urinate, and urine is spontaneously excreted drop by drop.
• Both chronic and acute ischuria can be either complete or incomplete. In the case of complete - independent urination is not possible, and in case of incomplete - emptying occurs with difficulty.

Causes of ischuria

Ischuria may occur due to:

• diseases and traumatization of the nervous system (injuries of the spine, hemorrhages in the brain);
• multiple sclerosis and hysteria;
• severe infectious diseases (for example, typhoid malaria);
• pronounced phimosis;
• stones in the bladder, urethra;
• adenomas, prostate cancer;
• inflammatory processes with hemorrhoids, adnexitis, peritonitis;
• injuries of the urethra, bladder;
• surgery and childbirth.

Acute ischuria may appear suddenly after great mental or physical stress, as well as after taking alcoholic beverages.

Symptoms of ischuria

In acute complete ischuria due to diseases of the prostate gland (malignant tumors, adenoma, abscess) as well as injuries, patients are very restless, they feel sharp pains in the suprapubic area with periodic strong urges, they try in vain to urinate, taking various positions. In men, the pain radiates to the penis.

With ischuria against the background of diseases of the nervous system, urination urges either do not appear at all, or are very mildly expressed, the patient is calm, despite the pronounced overflow of his bladder. During the diagnosis, a certain neurological syndrome is detected (paresis, sensitivity disorders, etc.)

Ischuria may be accompanied by such additional symptoms:

• problems with bowel movements (constipation);
• decrease or lack of appetite;
• nausea and vomiting;
• increase in body temperature;
• sleep disorders.

Diagnosis of ischuria

Complete ischuria (both acute and chronic) is diagnosed without difficulty. In the case of severe urinary retention, a physical examination in the suprapubic area reveals a bulge, which is associated with overflow of the bladder. Percussion (tapping) can be performed, which allows you to determine the boundaries of an overflowing bladder.

In less severe cases of ischuria, ultrasound diagnostics of the bladder and kidneys is performed. Also, incomplete urinary retention can be diagnosed in the presence of a large amount of urine (more than three hundred milliliters), which is determined by catheterization carried out immediately after the act of urination. The determination of residues can also be carried out by introducing radioisotope agents, which are rapidly excreted by the kidneys and deposited in the bladder along with the remaining urine after urination. In addition, the following diagnostic methods are used:

• complete blood count (to determine the symptoms of the inflammatory process);
• urinalysis (to detect inflammation in the urinary tract and kidneys);
• biochemical blood test (performed to detect various abnormalities in the functioning of the kidneys);
• ultrasound diagnosis of the prostate.

Ischuria treatment

In the case of acute ischuria, emergency care is needed, which consists in the artificial emptying of the bladder, restoring the normal outflow of urine. At the prehospital stage of medical care, emptying is carried out by means of catheterization or puncture of the bladder in the suprapubic region.

With reflex ischuria, attempts are made to establish reflex emptying (the sound of flowing water from a tap, irrigation of the genitals with warm water). If these methods are ineffective, medications are used. Prozerin (a cholinesterase inhibitor) is administered subcutaneously. Catheterization is indicated if these drugs do not cause the desired result. At the same time, drugs for oral administration are prescribed: chloramphenicol, furazolidone or furadonin, as well as blacks to prevent pyelonephritis and cystitis.

Complications of ischuria

With untimely, as well as improper treatment, ischuria can cause the following complications:

• infectious diseases (cystitis and pyelonephritis);
• chronic renal failure;
• the occurrence of bladder stones;
• hydronephrosis of the kidneys;
• bladder diverticulum.

Ischuria prevention

In order to prevent urinary retention is necessary.

Paradoxical ischuria is a condition in which the bladder cannot empty completely. As a result, a large amount of urine accumulates in it, due to which its periodic involuntary leakage is observed. With overcrowding, the patient experiences discomfort and severe pain in the lower abdomen.

Men are more likely to experience pathology. In women, it is diagnosed less frequently.

What causes ischuria?

Paradoxical ischuria is a common symptom of urological diseases, that is, it is not considered a separate disease. According to statistics, 85% of all cases of urinary retention affect men over the age of 55, which is due to inflammation of the prostate.

Among other reasons leading to a pathological condition:

• Mechanical obstruction of the urethra. It may contain stones, tumor neoplasms, blood clots. Also, mechanical obstruction may be due to edema - for example, with prostate adenoma, the surrounding structures, including the urethra, swell.
• Prolonged stay of the patient in a state of severe stress. Nervous experiences can provoke inhibition of reflexes responsible for full urination. The reason is more typical for people who have mental disorders.
• Dysfunctional disorders. This refers to disorders of nerve conduction in neurological diagnoses, dystrophy of the muscular layer of the bladder and other conditions in which normal contraction of the organ becomes impossible.

Certain medications can cause the problem. So, a number of sleeping pills and narcotic drugs cause urinary retention and have a depressing effect on the contractility of the bladder.

Types of disease

Paradoxical ischuria is classified into types according to the criteria:

• The preserved ability to urinate.
• Delay duration.

If the patient, by strongly straining the muscles, can empty the bladder at least a little, they speak of an incomplete delay. If it is possible to remove stagnant urine exclusively with the help of a catheter, a diagnosis of complete paradoxical ischuria is made.

As for the duration of urinary retention, there are two forms:

1. acute. Develops like an attack. There are severe pains in the pubic bone area, the urge to urinate becomes pronounced. Visually, the doctor sees a protrusion in the lower abdomen.
2. Chronic. The patient's condition worsens gradually. For several weeks/months, he complains of a feeling of incomplete emptying, and then there comes a point when he cannot empty his bladder at all on his own.

Symptoms

In the acute form, the patient experiences irresistible urge to go to the toilet. However, no urine comes out, even when he presses hard on his abs. Cutting pains appear in the lower part of the abdomen. As the biological fluid accumulates above the pubis, a characteristic protrusion in the form of a roller appears. In parallel, the patient may complain of insomnia, increased fatigue, loss of appetite and constipation.

With chronic paradoxical ischuria, the symptoms are not so bright. A person feels that his urinary bladder is not completely emptied. He goes to the toilet frequently, but the amount of urine he passes gradually decreases even if he drinks a lot of fluids. During urination, the patient strains strongly. The stream of urine is constantly interrupted. To feel relief, the patient can spend 5-10 minutes in the toilet.

Diagnosis of the disease

On palpation / examination of the patient's abdomen, the doctor feels / sees a protrusion. To alleviate the patient's condition, he is given an antispasmodic and urine is excreted using a catheter. After conducting research aimed at establishing the cause of ischuria:

• General blood and urine tests.
• Cystoscopy.
• Abdominal ultrasound.
• Endoscopy and x-ray with contrast.

To assess the size of the prostate gland, a man may be asked to undergo a TRUS. If there is a suspicion that the ischuria of the paradox is provoked by nervous experiences, the patient is referred for a consultation with a neurologist, a psychiatrist.

Treatment Methods

Treatment for this condition can be divided into:

• emergency- designed to alleviate the patient's condition.
• Comprehensive- ensures the elimination of the causes that provoked the symptom, relieves inflammation.

In the first case, carry out bladder catheterization. If it turns out that it is impossible to install a catheter (for example, with a tumor, stricture, phimosis), an epicystostomy is performed: with the help of a surgical intervention, they gain access to the bladder and insert a tube into it that leads the biological fluid towards the anterior surface of the abdomen.

As for complex treatment, it depends on the cause that caused urinary retention. If a calculus or a tumor is to blame, an operation is performed. In dysfunctional lesions, urologists work together with neuropathologists and surgeons. They prescribe medications taking into account the age of the patient, the presence of chronic ailments, the severity of ischuria and some other factors. In each case, drug treatment is selected individually.

With urinary retention resulting from stress, sedative pills and herbs help well.

Prevention of ischuria consists in the timely detection and high-quality treatment of diseases of the genitourinary system, as well as pathologies that lead to damage to the prostate (in men).

Possible consequences and complications

The prognosis is favorable. The main thing is to quickly establish the cause of paradoxical ischuria and conduct its competent treatment. In advanced cases, the disease can lead to acute renal failure, bilateral hydronephrosis.

Chronic ischuria of the paradox is fraught with inflammation and infection of the urinary tract.

Ischuria is urinary retention, the impossibility of emptying the bladder, despite its overflow with urine. Ischuria is caused by a variety of reasons; occurs more often in men, less often in women and children.

There are the following types of ischuria: 1. Acute full - comes on suddenly, accompanied by pain, urge to urinate. 2. Acute incomplete - with this form of ischuria, a small amount of urine can be excreted. 3. Chronic complete ischuria - independent urination is impossible, urine is released by a catheter for years. 4. Chronic incomplete ischuria - the patient urinates, but cannot completely empty the bladder, part of the urine remains (residual urine), its amount can sometimes reach a thousand or more milliliters. 5. Paradoxical ischuria - a special form in which the bladder is overstretched, voluntary urination is impossible, but urine is involuntarily released from the urethra in drops. This happens due to the onset of atony of the muscle wall and overstretching of the sphincters of the bladder. 6. Ischuria can occur reflexively after a mental shock and various surgical interventions - postoperative or postpartum.

Complete acute ischuria must be distinguished from anuria (see). In anuria, the bladder is empty, there is no urge to urinate, while in acute ischuria the bladder is distended, filled with urine, and there is frequent urge to urinate. Acute forms of ischuria are painful for the patient. Chronic ischuria proceeds unnoticed by the patient and is often detected in an advanced stage. The causes of ischuria can be mechanical obstructions in the urinary tract (most often the prostate, tumor, prostate abscess, stones and tumor of the bladder, narrowing of the urethra of an inflammatory and traumatic nature, trauma to the pelvic organs and lower urinary tract) or diseases or damage to the head and. Acute ischuria requires emergency care (single or systematic catheterization). If the rubber catheter cannot be passed, a suprapubic puncture of the bladder is used. The latter, as well as catheterization (see) with a metal catheter, must be performed by a doctor. Such patients should be immediately referred to a hospital for specialized care or suprapubic bladder surgery.

With ischuria caused by a disorder of the innervation of the lower urinary tract, catheterization usually does not cause difficulties.

With postoperative and postpartum ischuria, the main task is to remove urine without resorting to catheterization. You can try to induce urination with the sound of a flowing stream of water, by irrigating the external genitalia with warm water, by injecting 5-10 ml into the urethra. 1-2% novocaine solution. Intravenously administered 5-10 ml, 40% solution of hexamethylenetetramine (). Subcutaneous

ISCHURIA PARADOXA (from the Greek ischo- I hold back and ouron-urine), a term adopted to refer to a peculiar symptom of urination disorder, expressed by spontaneous excretion of urine drop by drop from a bladder filled to the maximum, with the complete impossibility of its arbitrary emptying. This symptom is observed in many diseases of the spinal cord, with tabes, in the initial stages of transverse lesions of the spinal cord, different in their pathogenesis (myelitis, compression); in the further course of b-ni, it gives way to a more normal, periodic emptying of the bladder, with Krom at long intervals (V s -2 hours), significant portions of urine flow out, which indicates isolation of the spinal center of urination from the cerebral cortex, as a result of which bubble activity becomes automatic; however, the emptying of the bladder is not complete, since the removed portions are less than normal. Elimination of I. paradoxa is achieved by treating the underlying spinal cord ailment. A. Surkov. I. r. it is observed as well at nek-ry urologist, diseases. With the so-called. prostate hypertrophy (in the third stage) c. m. e. t. hee. I. r. is the main symptom of this stage of the lesion. In addition, I. p. it is also observed with a long-term, pronounced narrowing of the urethra, which makes it difficult to empty the bladder, causing the bladder muscle to hypertrophy at first, and then stretch and lose its normal tone. In the previous stages of prostate hypertrophy and urethral stricture before the onset of symptom I. p. is always observed hron. urinary retention (residual urine) in the presence of frequent voluntary urination. In the future, when the reserve forces of the muscular apparatus of the bladder are exhausted, complete atony occurs not only of the detrusor, but also of the sphincter, and so on. disrupted coordination between both muscular apparatus of the bladder, normally acting as antagonists. With I. p. the detrusor and sphincter are simultaneously in a state of relaxation, which explains the constant urinary incontinence when it is impossible to empty the overflowing bladder. The I.R. caused by urethral stricture is usually eliminated after the destruction of the obstruction by systematic expansion of the canal or, even better, by internal urethrotomy. After the operation, the bladder begins to empty itself by restoring the contractility of the detrusor. I. r. with prostate hypertrophy, it can be eliminated by removing the underlying cause of the disease, i.e. e. prostate adenomas. However, this is only possible in a minority of cases. Usually I. p. with prostate hypertrophy occurs when there is already such a significant stretching of the upper urinary tract, followed by atrophy of the renal parenchyma, that the operation does not make sense due to insufficient kidney function. Therefore, all methods of fnkts should be applied to such patients. diagnosis of the kidneys, and on the basis of this study, the question of a radical or conservative method of treatment should be decided. With prostate hypertrophy, in cases where there are contraindications to the removal of the prostate gland, partial elimination of I. p. by systematic catheterization (3-4 times a day) or the use of an indwelling catheter. Catheterization, especially at the beginning, should be done carefully, and the bladder should be emptied gradually rather than in one session to avoid ex vacuo bleeding. Catheterization should be carried out with careful asepsis, since the atonic bladder becomes extremely easily infected. This is especially important when I. p. with clear urine. Simultaneously with catheterization, disinfectants are prescribed orally or intravenously. Wearing a rubber urinal is recommended to avoid skin irritation from persistent urine and to eliminate stench. I am. gotlib. Lit.: G u o n I., Lecons cliniques sur les maladies des voies urinaires, t. I, P., 1903 (Russian ed. - St. Petersburg, 1899); Schwarz O., Pathologische Physiologie der Harnblase (Hndb. d. Drologle, hrsg. v. A. Lichtenberg, F. Voelckeru. H. Wildbolz, B., 1926).

What is paradoxical ischuria? Ischuria is a condition when, due to urinary retention, the bladder overflows. Most often, this diagnosis is made to men. In women and children, if such a pathology is detected, it is very rare.

The essence of the problem

There are the following types of disease:

1. Acute complete ischuria. This condition appears suddenly and begins with a sharp pain and multiple urge to urinate. Very often this form is confused with another form, but already anuria. In this case, urine also does not come out, but for a completely different reason. Anuria is called pathology, when urine is delayed due to the fact that the bladder is not filled with it. In this case, there is no urge to urinate.
2. Acute incomplete form. The urethra is also full, but very little urine is produced.
3. Chronic full - the urea is also full, but emptying does not occur without auxiliary means, in particular without the use of a catheter. Moreover, it has been emptied in this way for quite a long time: from several months to several years.
4. Chronic incomplete form. With this development of pathology, the organ is emptied, but not completely. The remaining urine is 80% of its volume. Urinary retention in this case can be caused by various reasons.

How does the disease develop?

The paradoxical form occurs due to excessive stretching of the sphincters of the bladder. In this case, the body does not empty itself. Urine may be excreted, but only in small drops and involuntarily.

For example, an acute attack of the disease is accompanied by a sharp pain, so a person runs to the doctor with all his might. A completely different situation develops in the chronic form. In this case, the disease proceeds without any symptoms. All symptoms may appear in the later stages when urosepsis develops.

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Any form of illness is quite dangerous. The acute form may occur as a result of injury to the urethra or urea, or blockage of the latter by sand or stone.

The acute incomplete form occurs for other reasons, which include spinal cord injuries, bruises, the effects of typhoid fever, malaria, cerebral hemorrhages. But the most common cause is prostate adenoma. Sometimes the cause is cancer of the prostate or bladder. Sometimes ischuria can occur after an unsuccessful spinal anesthesia.

It is very difficult to diagnose incomplete ischuria. First, the doctor needs to determine the cause of incomplete urination, then take measures to eliminate it. It is also important to immediately make the correct diagnosis and not mistake anuria for ischuria.

Treatment Methods

Each form of ischuria has its own approach to treatment. In acute ischuria, first of all, the patient is helped to empty the bladder using a catheter. If the pathology occurs in the postpartum period, they try not to use the catheter. In this case, the genitals are poured with water, novocaine is injected into the urethra. And only if all these measures did not give the desired result, catheterization is performed.

They tend not to use a catheter for one purpose - in order not to infect the bladder. Therefore, during the procedure, antibiotics are prescribed for prevention: Furadonin, Furagin, Urosulfan, Levomycetin.

If catheterization is done regularly, then the bladder must be washed with Rivanol or Furacilin.

In general, ischuria is quite curable and the prognosis is always favorable. But in difficult cases, there may be complications in the form of cystitis, kidney damage, bladder infection.

And at the same time, ischuria is considered a rather dangerous secondary symptom, especially in bladder cancer.

Acute ischuria is characterized by severe pain, so this condition requires immediate first aid, which consists primarily in relieving pain and, if possible, helping to empty the bladder.

At home, it is recommended to place heat on the bladder area. It can be a heating pad or a bottle of warm water. Doctors also advise making a cleansing enema or, if there is a candle with Belladonna in the medicine cabinet, insert it into the rectum. Traditional medicine advises for acute ischuria to drink tea with mint, linden and chamomile.

But these measures can be used only if it is not possible to consult a doctor. In other cases, it is necessary to call an ambulance in order to determine the cause of ischuria as soon as possible.

Proper diagnosis in acute ischuria is very important. But in order to conduct it qualitatively, it is necessary to empty the bladder. For this, a catheter is again used, and only after that laboratory tests are prescribed: urine and blood tests.

In men, an analysis for the presence of prostate-specific antigens is mandatory. This is necessary to identify pathologies of the prostate. If necessary, surgical intervention is offered.

Additionally, the doctor prescribes:

• ultrasound diagnostics of the bladder and prostate gland;
• urodynamic test;
• cystoscopy;
• x-ray.

Ultrasound is one of the most important diagnostic methods, especially in acute forms of ischuria, since only this study will give a complete picture of the pathology.

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Treatment is carried out only after receiving the data from the analyzes of diagnostic procedures. For example, in acute ischuria, the standard treatment regimen includes:

1. Medicines.
2. Installation of a catheter. The placement time and type of catheter depends on how serious the problem is.
3. Bladder puncture.
4. Epicystostomy. This method is used if it is necessary to remove urine from the bladder for a long time.

In other cases, treatment is carried out on an individual basis, taking into account the primary diseases, the secondary symptom of which is ischuria. For example, with prostate cancer, a catheter is necessarily installed and only after that the rest of the treatment is prescribed. When the catheter does not solve the problem, a cystoma is placed. With ordinary prostatitis, a troactary cystostomy is performed. It is also prescribed for injuries of the urethra.