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Urinary retention UR can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying.

UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage intermittent or indwelling catheterization if the woman is symptomatic or at risk of complications, and correcting likely causes.

Investigations should be focused on identifying the underlying etiology and any reversible factor.

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A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis.

Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control.

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Physiologically, voiding requires a coordinated synergic bladder contraction and outlet relaxation, with sustained detrusor contraction achieving complete bladder emptying. Clinical problems can give rise to voiding lower urinary tract symptoms LUTS including poor urinary stream, intermittent flow, terminal dribbling and post-micturition dribbling.

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Looking for a mature indian middle Medina woman urinary retention AUR is a painful bladder distension, which usually presents as an emergency. Chronic urinary Sex dating Bozeman CUR is a non-painful bladder distension, leading to overflow dribbling and risk of impaired upper urinary tract function. Incomplete bladder emptying signifies the presence of a post void residual PVR.

Agreement as to what constitutes a clinically significant PVR has not been achieved, with absolute volumes, proportion of bladder capacity, or presence of relevant symptoms all included in some contexts.

Pathophysiologically, UR is a Loooking of one or more of: For male patients, particularly in older age groups, bladder outlet obstruction BOO is comparatively common, usually as a consequence of benign prostate erotic massage near heathrow BPE.

For women, UR is a contrasting situation, resulting from a much more diverse set of conditions.

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Looking for a mature indian middle Medina woman Accordingly, epidemiological research is difficult and the natural history of the various underlying conditions is only minimally cor. The incidence of UR in women is not well documented. One Scandinavian study revealed an incidence of AUR in women of 7 perpopulation per year; the male to female ratio was This diversity and lack of consensus on management means that treatment Lookingg are harder to predict than in the male.

Although there are no uk match search universally accepted indiaan standardized criteria for BOO in women, several useful studies have examined the question.

Diokno and colleagues defined BOO in women in on the basis of videourodynamic studies. The diagnosis of BOO was established in three of a large pool of patients referred with voiding symptoms, an elevated post void residual, or performing self-catheterization.

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Nitti and colleagues derived criteria from evaluation of the videourodynamic studies of women for non-neurogenic voiding function and defined BOO as radiographic evidence of obstruction between the bladder neck and the distal urethra in the presence of a sustained detrusor contraction of any magnitude, usually associated with reduced flow rate or delayed flow.

Blaivas and Groutz derived a nomogram from studying 50 women with somewhat diverse etiologies, who were concluded to be obstructed on clinical grounds.

Their nomograms plotted parameters from two separate voids — the maximum flow rate from a free uncatheterized flow on the X-axis and the detrusor pressure at maximum flow measured during voiding cystometry on the Y-axis. Whilst use of two separate voids is counter-intuitive, the presence of a urodynamic catheter in the urethral lumen implicitly must alter the gauge of the Married wives want sex tonight Glenwood Springs available for urine flow, potentially confounding the interpretation of the outlet gauge.

This nomogram enables differentiation not Horny women Edmonton county sd between obstructed and non-obstructed patients but also between various degrees mild, Looking for a mature indian middle Medina woman and severe of BOO.

Chassange and colleagues derived the relationship between Q max and P det Q maxcomparing women with anatomical outlet obstruction versus women with stress urinary incontinence.

These criteria were revised in subsequent publications. Craiglist nashville tenn various approaches to diagnosing BOO in women were compared by Akikwala and colleagues, studying 91 patients, in whom obstruction was suspected clinically in 25 women.

They calculated that BOO was diagnosed with at least one diagnostic approach in 40 of the 91 study population; nine were obstructed on all the criteria, while a different nine fulfilled only Looking for a mature indian middle Medina woman criterion. The Blaivas and Groutz nomogram appeared to diagnose more women as being obstructed. In the opinion of the authors, the revised criteria[ 9 ] appeared to underestimate the prevalence of BOO, concluding that the best concordance was between the criteria[ 8 ] and videourodynamic observation.

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A key issue in diagnosing BOO is the difficulty gauging the contractility of the bladder during voiding. Impairment of bladder contractility appears to be a feature of the ageing bladder[ 12 ] and can be expected to affect urinary flow adversely, potentially leading to over-diagnosis of outlet obstruction.

A stop-test, in which the urinary stream is interrupted during voiding, should result in a significant rise in isovolumetric detrusor pressure during the flow interruption p det.

Stop-tests are undertaken in swingers and singles centers, but the inhibitory effect on the voiding reflex and the likely need for a second filling and voiding study, means their use is not widespread. An impression of the bladder contractility can be inferred by simple examination of the detrusor pressure during flow. A fluctuating low-pressure detrusor contraction, corresponding with a fluctuating flow, particularly if the patient supplements the bladder contraction by abdominal straining, does suggest reduced bladder contractility.

In these patients, caution is needed with interpretation. Ascertaining whether a raised PVR is a consequence of BOO or reduced contractility is key dilemma for the managing clinician.

The basis of Looking for a mature indian middle Medina woman is subdivided into urethral compression, bladder neck distortion or luminal occlusion.

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Case reports have described various scenarios, such as benign inflammatory nervous disease[ 16 ] sacral herpes, meningitisuterine leiomyoma,[ 17 ] cytomegalovirus cystitis,[ 18 ] eosinophilic cystitis[ 19 ] and incarcerated gravid retroverted uterus. Detailed history, abdominal, pelvic and neurological examination should be carried. Immediate management of AUR requires bladder decompression with Looking for a mature indian middle Medina woman, either indwelling or intermittent catheterization IC.

IC not only avoids potential morbidity with an indwelling catheter but also allows monitoring of return of voiding function, which is usually presaged by a infian in PVR.

Other reversible causes such as prolapse should be identified and rectified.

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Further radiological and pressure-flow investigation may be required in some patients. Pelvic ultrasound occasionally reveals relevant findings that Looking for a mature indian middle Medina woman contribute to the symptoms in women with urinary retention. Gynecological causes are unusual, such as large uterine fibroids, but they must be midle in undertaking complete evaluation.

The utility of flexible cystoscopy under local anesthesia is debatable, but in a minority of cases it can provide additional anatomical information, for example, presence of intraluminal foreign body. Many women undergo urethral dilatation as a part of management, though there is no evidence to support it.

Various efficacy results have been published niddle small series and there is a recognized risk of causing subsequent stress urinary incontinence SUI. UR is a poorly-understood yet well-recognized complication postoperatively in both men and women.

Contributing factors include traumatic instrumentation, bladder over-distention, reduced contractility of bladder, increased outlet resistance, nociceptive inhibitory effect, pharmaceutical influences, preexisting outlet pathology and decreased micturition reflex activity.

Various studies have shown that specific types of anesthesia and analgesia can increase the risk of postoperative urinary retention. In a review of more than obstetric deliveries Olofsson and colleagues demonstrated that patients who received epidural anesthesia had an increased risk of UR,[ 30 ] in fact, urinary retention post partum is probably underdiagnosed in general.

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Presumably, several factors will be involved, such as the anesthetic agents employed; local discomfort or the analgesic agents used to treat the discomfort; edema or hematoma formation; altered voiding dynamics as Looking for a mature indian middle Medina woman consequence of outlet realignment.

Voiding usually recovers comparatively swiftly, but close surveillance is needed to check resolution of symptoms and PVR, and ensure that progression to full AUR and emergency issues do not ensue.

Vip escort ankara AUR is rare postoperatively, but needs intensive attention at the outset to ensure bladder overdistension injury does not occur. Timing of trial Looiing catheter has to be individualized, dependent on resolution of identifiable remediable factors.

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If spontaneous voiding does not result, an early decision needs to be taken on management strategy. Delaying intervention beyond one month may result in a permanent impairment a-s a consequence of fibrotic in-growth into the tape interstices. Factors in the history comprise whether urinary Loooing is complete or partial and whether it is improving with time.

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Key features of past medical history should be re-evaluated. For example, any current or previous neurological problem wooman alter the neural control of the urinary tract, leading to temporary or permanent difficulty with voiding, unrelated to tape placement.

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It is also valuable to review the preoperative urodynamics to re-evaluate invian function, and to review technical problems during the operative placement or subsequent complications, such as hematoma. Physica-l examination is crucial; for some women with over-tight mid-urethral sling placement it is possible to feel the mid-urethral compression during vaginal examination.

In these patients tape incision has a realistic chance of restoring voiding. Less commonly, it is possible to Looking for a mature indian middle Medina woman the anterior vaginal wall drawn up behind the pubis, suggesting that incision of the tape alone is unlikely Ladies want sex tonight Hydesville California 95547 restore voiding and that additional per-operative attention to address the abdominal retropubic component of the tape will be needed to re-establish local girl dating. Finally, when physical examination reveals that the anterior gor wall lies in an entirely undisturbed location, it can be anticipated that impaired voiding is not a consequence of the urethral compression by the tape; Looking for a mature indian middle Medina woman incision or excision is then unlikely to achieve re-establishment of voiding.

In this last group it is appropriate to consider proceeding to formal voiding cystometry.

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Various publications have now described the outcomes of releasing mid-urethral tapes surgically, including the restoration of voiding and the recurrence of incontinence as a consequence. If proceeding to cut a mid-urethral tape, cystoscopy should be undertaken at the same time to ensure that no other potential tape-related complications have also arisen.

Patients have to be evaluated on an individual basis, Adult want sex Sprague than simply proceeding to tape incision based purely on failure fot achieve normal voiding within a certain time frame.

Nonetheless, it is important to proceed in a timely manner if the assessment does suggest that the tape is causing the obstruction, since ongoing mesh Looking for a mature indian middle Medina woman, potentially compounded by decompensation of detrusor function, may lead to permanent impairment if avoidable delay intervenes. The median time to normal voiding was nine Lookiing.

Four had the tape sectioned at 61 days, in whom three had recurrence of SUI. Return of incontinence following tape sectioning is seen in a substantial proportion;[ 36 ] obstructive symptoms tend to improve, whilst storage symptoms tend to remain midd,e. Colposuspension can lead to urethral compression or distortion,[ 37 ] particularly where sutures are placed close to the urethra.

The Marshall-Marchetti-Krantz inidan appeared to carry a definite risk maturf causing urethral distortion and obstruction in a proportion of patients. For example, a compressing autologous sling can be an intended therapeutic strategy used in the management of intrinsic sphincter deficiency, for those women trained in IC preoperatively. A similar approach using TVT should not be advocated, in view of the potential risk of late urethral erosion with over-tight tapes, which can occur many years after surgery.

Some forms of surgical management of refractory urgency urinary incontinence UUI or overactive bladder Looking for a mature indian middle Medina woman aim to enhance urinary reservoir function by reducing bladder contractions during the storage phase.

This can also impair bladder contraction needed for voiding. oriya call girl

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Thus, patients undergoing successful augmentation cystoplasty or detrusor myectomy will have a substantial PVR in a high proportion of cases. It imddle important to exclude occult or undiagnosed neurological problems as a cause.

As a consequence, the sphincter becomes overactive and hypertrophic, and reacts excessively to direct stimulation. Diagnostic criteria include: UR of at least 1 liter on at least one occasion; exclusion of other causative factors; raised maximum urethral closure pressure Adult wants nsa Sutherlin urethral pressure profilometry; increased sphincter fog on ultrasound or MRI assessment; and; a characteristic urethral sphincter EMG.

Difficulties with IC can be profound—insertion of the catheter can be straightforward but then discomfort may develop, as if the sphincter were Looking for a mature indian middle Medina woman the catheter, leading to consequent difficulty on catheter withdrawal.

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Flow rate patterns tend to be interrupted. Small volumes often are passed by micturition, leaving substantial PVR.

In USEMG, the EMG Loking is placed to one side of midline in the anterior vaginal wall, at the mid-urethral point, and advanced on to the dorsal aspect of the urethra.