DD URINARY RETENTION

M. REZA IZUL FATAH

DIFFERENTTIAL DIAGNOSIS
Acute
Most common :
Benign Prostate Hyperplasia,
urolithiasis
Chronic
1. Diabetic Neuropathy
2. Urethral Stricture
3. Parkinsons Disease

CONT..
Lower Urinary Tract Obstruction
1. BPH
2. Urethral Stricture
Upper Urinary Tract Obstruction
3. Urolithiasis
4. Retroperitoneal Fibrosis

BPH
DIAGNOSE
Symptom
Urinanry urgency, hesistancy,
slowstream, and nocturia ( symptoms
not specsific, its sympstom like :
urethral strictures, neuron dysfunction
from diabetes, parkinsons disease)
Gross hematuria, AUR

PSA
PROSTATIC SPESIFIC AGENT
PSA is normally present in low
concentrations
PSA levels may be elevated in the
blood of men with benign prostate
conditions such as prostatitis and
benign prostatic hyperplasia, as well
as in men with prostate cancer
Normal range : < 4,0 ng/mL, if
elevated : biopsy prostate

RECTAL TOUCHE

INTERPRETATION
20 g if sulcus medianus palpable
until the edge of prostate
40 60 g If sulcus medianus
paplpable until the edge of prostate
but need more force to achive it.
> 60 unpalpable

DIABETIC NEUROPATHY
DIAGNOSE
SYMPTOM
Loss of sensory function
Motor neuropathy/ charcot foot
Loss of autonomic function
Low reflects
Pallor and coldness feet
Ulcer painless deep tissue and bones
Persistent soft tissue infection peripheral
vascular compromise gangrene

GLUCOSE TOLERANCE TEST

In the oral glucose tolerance test, the
patient is fasted overnight, and a
basal glucose value is determined.
40g/m2 of glucose is given orally
over 10 minutes. Blood samples are
taken every 30 minutes for 2 hours.
Normal values and criteria for
diabetes vary by age, but essentially
all values should be <200 mg/dL,
and the 120-minute value should be

AUTONOMIC NEUROPATHY TESTING

GENITOURINARY SYSTEM
Urodynamic testing
Urodynamic testing is any procedure that
looks at how well the bladder, sphincters,
and urethra are storing and releasing urine.
Most urodynamic tests focus on the bladders
ability to hold urine and empty steadily and
completely. Urodynamic tests can also show
whether the bladder is having involuntary
contractions that cause urine leakage

URETHRAL STRICTURE
Symptom is similiar to BPH
Strictures may result from scarring
due to infectious urethritis, prior
instrumentation, trauma, or cancer.
Diagnosis is by retrograde
urethrogram or cystoscopy.

RETROGRADE
URETHROGRAM

PARKINSONS DISEASE
DIAGNOSE
Symptom of voiding is similar to BPH
Symptom
1. Tremor or shaking
2. Bradykinesia (slowless of
movement)
3. Rigidity (stiffness) arms, legs, or
trunks
4. Postural instability balance
problem & possible falls

CONT..
Other Symptom
Constipation, dementia, depression,
dysphagia, urinary incontinance
(bladder weakness), urinary retention,
impaired motor coordination, etc

DIAGNOSE
Two of the four main symptoms must
be present - for a neurologist to
consider a Parkinsons disease
diagnosis.
Confirmation with PTE (positron
emission tomography) for detect
dopamin level in the brain

UROLITHIASIS
Urinary Calculus Disease
Calculi are crystalline aggregates of one
or more components, most commonly
calcium oxalate. They also may contain
calcium phosphate, magnesium
ammonium phosphate (struvite), uric acid,
or cystine. Calcium and struvitecontaining stones often are visible on
plain radiographs, but CT scans will
demonstrate all calculi

SIGN & SYMPTOM

Nausea
Flank pain
Colic pain
Urinary retention complete
obstruction
Hematuria

DIAGNOSE
Urine (identifity type of stone)
Hiper kalsiuria phosphate &
cacium stone
Phosphate amonium magnesium
stone occur in chronic infection
who bacteria produce urease so urine
become alcali because of
degradation of ureum
Hiperuremia uric acid stone

DIAGNOSE
Sedimentation of urine abnormal??
Sensivity of microbe
Culture
Renal function
Ureum
Kreatinin
Elektrolite
CT SCAN

CT SCAN

RETROPERITONEAL
FIBROSIS
Retroperitoneal fibrosis is a process
resulting in encasement of the
ureters, along with the great vessels,
in a dense fibrotic mass.
imaging demonstrates medially
displaced ureters with a
homogeneous, plaque-like mass in
the retroperitoneum

SYMPTOM
Initially, patients complain of the
insidious onset of dull, poorly
localized abdominal pain. Suddenonset or severe abdominal pain may
signify acute mesenteric ischemia.
Other symptoms of retroperitoneal
fibrosis include unilateral leg
swelling, intermittent claudication,
oliguria, hematuria, and dysuria.

RADIOGRAPH

UROGRAPHIC IMAGE

UROGRAPHIC