Urgent measures in some emergency situations in urology at the prehospital stage

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B. A. Selius, R. Subedi Am Fam Physician 2008;77(5):643-650

Shading the cut is the impossibility of releasing the cut. The problem of bleeding occurs when you are sick and you are unable to urinate, which is often accompanied by pain. In case of chronic tightness, the cuticle in the cuticle shows a displaced amount of the excess cuticle, which is often not accompanied by pain. When the cut is congested, patients may experience excessive discharge of the cut, insufficient emptying of the cut, or beware of ischuria paradoxa (more visible cut when the cut is overfilled). Closing of the cut can be complicated by the development of infection or deficiency.

Zgіdno with the results of the Great Popular Popular Doslizhen (Jacobsen SJ et al., 1997; Curtis la et al., 2001) Seredovikiv wkom 40–83 Rockivas, spent the frequency of the Goststroms of Sich to 4,5–6,8,8,8,8,8,8,8,8,8 falls per 1000 people per river. This number increases sharply with age, the chance of developing gastrointestinal tract in 70-year-old people becomes 10%, while in 80-year-old people it is more than 30%. The frequency of development of the gastrointestinal tract in women is unknown. Although the range of illnesses for differential diagnosis of etiology and treatment is wide, with the help of a detailed history, physical examination and various diagnostic tests, the family doctor can make an early diagnosis and provide further assistance.

Etiology of cutting up the battle

The reasons for the development of inflammation can be divided into obstructive, inflammatory-infectious, pharmacological, neurological and others.
(div. table 1). Table 1. Etiology of shading

Features of urinary retention in women

Among women, this pathology is less common and is characterized by similar symptoms. It can be acute or chronic (develops in stages).

The causes of the disease should be noted as follows:

• disorders of the innervation of the bladder: complications after myelitis, spinal cord injuries, congenital pathologies of the bladder, after natural childbirth;
• urinary tract infections;
• drug therapy: after taking antihistamines, antispasmodics, sleeping pills;
• urolithiasis disease;
• pregnancy;
• deformation and prolapse of the pelvic organs.

If you neglect the treatment of this disease, kidney failure, acute cystitis, and pyelonephritis may develop.

Obstructive causes of shading

The shading of the cut may result from obstructive changes in the lower sectoid lines near the neck of the sectum or distal to it. Obstruction of the urinary tract can be caused by internal factors (for example, enlargement of the prostate, stones in the urinary tract, urethral stricture) or external factors (for example, compression of the cervix of the urinary tract by a swollen uterus or SCC), protease The most common cause is benign prostatic hyperplasia (BPH). The results of a 2-year follow-up (Choong S. et al., 2000) involving 310 people demonstrated that in 53% of patients the blockage was caused by BPH, and in the other 23% by other obstructive factors. In the United States, BPH causes approximately 2 million visits to the doctor and more than 250,000 surgical procedures.

Blockage of the section can be caused by other obstructive disorders, such as prostate cancer, phimosis, paraphimosis, compression devices, tension on the penis in men, cystocele or rectocele in women. External compression of the cervix of the sechovogo mikhur as a result of prolapse of the uterus, the presence of large swellings of the pelvic organs, ShKK or other space, fecal blockage can also cause blockage of the mesh. In men and women, strictures, stones or foreign objects in the urethra can completely block the passage of the urethra. With swollen fur, the swelling of the skin often results from the presence of blood clots, and illness often manifests itself as hematuria without pain.

Help with acute urinary retention

The acute form is characterized by severe pain in the suprapubic region, which then covers the entire peritoneal area and an intense urge to urinate. A serious consequence of this condition can be rupture of the bladder. Emergency assistance required.

It is as follows:

• Catheterization is the removal of dangerous fluid using a catheter. This is an elastic tube that is inserted into the urethra.
• Cystostomy is a surgical procedure involving dissection of the bladder. The method is used if catheterization is impossible due to blockage of the urinary canal.

Both types of assistance should be carried out only by medical professionals who have sufficient experience. Before the specialist arrives, you can only use distractions, turn on the water tap so that the sounds trigger reflex urination, and take a warm foot bath.

Methods for diagnosing urological diseases:

• Calling a urologist to your home
• Diagnosis of kidney diseases
• Diagnosis of bladder diseases
• Diagnosis of prostate diseases
• Diagnosis of scrotal diseases
• Diagnosis of sexually transmitted infections
• Urine tests
• Tests for STIs
• PSA tests
• Ultrasound at home
• Kidney ultrasound
• Ultrasound of the prostate
• Ultrasound of the bladder
• Urological ultrasound at home
• Urethral swab
• Ultrasound of the penis
• Transrectal ultrasound
• Prostate juice tests
• Ultrasound of the genitourinary system

Fire-infectious causes of clogging

The most common etiology of acute inflammation caused by fire is acute prostatitis. Acute prostatitis is often caused by gram-negative microbes, such as Escherichia coli

and proteus, which results in a swelling of the inflamed prostate. Urethritis, referred to as an infection of the urinary tract or an infection carried by the urinary tract, can be accompanied by a swelling of the urethra and, apparently, a clogged urethra, with genital herpes we will as a result of local ignition changes and damage to the cranial nerves (Jelsberg syndrome). In women, painful inflammation of the vulva and vulvovaginitis can cause urethral swelling, painful secivation, which can lead to secrecy.

Pharmacological causes of shading

Drugs with anticholinergic activity, such as tricyclic antidepressants, may inhibit sepsis due to decreased detrusor muscle mass.
Sympathomimetics (for example, oral decongestants) cause suppression of inflammation by activating α-adrenergic receptors in the prostate and cervix. Based on the results of a population study, Verhamme KM et al. (2005), in people who were weaned off NSAIDs, the risk of developing acute inflammation was greater than in those who did not wean off these drugs; It is believed that the cause of this is the suppression of the rapid release of the detrusor, mediators of which are prostaglandins. Table 2 shows drugs associated with the development of the cut. Table 2. Drugs associated with the development of the cutaneous tissue (after Curtis LA et al., 2001)

Neurological causes of shading

The function of the urinary tract and the lower tracts is based on a complex interaction between the brain, the autonomic nervous system and the somatic nerves that innervate the urinary tract and the urethra.
When these nerve pathways are healed, the damage to the neurogenic genesis occurs (Table 3). Neurogenic or neuropathic mikur - this is a disruption of the function of the mikhur as a result of damage to its innervation. Table 3. Neurogenic causes of seborrhea obstruction and sechoviolation damage (after Ellerkmann RM, McBride A., 2003)

1Progressive illness of unknown etiology, which arises from a deficiency of the autonomic nervous system, including orthostatic hypotension, impotence in the brain, fastening, clenching or imperative non-trimming of the section anhidrosis, then symptoms of generalized dysfunction of the nervous system develop, such as parkinson-like disorders, cerebellar disorders, fasciculations “ulcers and decreased meat mass, tremors of the legs. (Note switch)

The infection due to neurological pathology occurs in men and women with the same frequency. Although the majority of patients with neurogenic michitis are to blame for untidy michitis, many such patients may also develop shading of the michium. Up to 56% of patients after a stroke suffer from sepsis, mainly as a result of detrusor hyporeflexia. In a prospective follow-up study (Kong KH et al., 2000), secrecy was observed in 23 of 80 patients who had suffered ischemic stroke, most of whom had relapsed within 3 months. c. Dysfunction of the migraine is evident in 45% of diabetics and in 75–100% of patients with diabetic peripheral neuropathy, which is most importantly manifested by clogging of the mikru. Decreased secretion correlates with the importance of overcoming multiple sclerosis and is observed in 80% of patients; suppression of the secretion develops in approximately 20% of patients. The interspine discs, trauma and compression of the spinal cord can cause damage to the nerve pathways of the spinal cord.

2.1. "ACUTE URINARY RETENTION ICD10: R33"

Appendix No. 1. Acute urinary retention not associated with BPH
Acute urinary retention in prostate cancer
In most patients with prostate cancer, the cause of AUR is both the prostate cancer tumor and concomitant BPH.
In this regard, the treatment tactics for such patients differ significantly. In patients whose AUR is due to the presence of concomitant BPH, it is necessary to offer management strategies for patients with BPH. All patients with AUR due to prostate cancer should first undergo bladder drainage. The prescription of α-blockers in such cases is ineffective, since the tumor tissue is insensitive to drugs of this group. However, spontaneous urination can be restored with adequate antiandrogen therapy. Therefore, patients with AUR suffering from hormone-sensitive prostate cancer need to evaluate the adequacy and effectiveness of antiandrogen therapy. If antiandrogen therapy is inadequate, it should be adjusted. Due to the low likelihood of restoring spontaneous urination in patients with hormone-resistant prostate cancer, palliative treatment methods are indicated to restore urine outflow: • partial transurethral resection of the prostate (which is performed 2-3 days or 4-6 weeks after an episode of AUR); • long-term catheterization; • suprapubic drainage of the bladder. Acute urinary retention with urethral stricture
Urethral stricture should first of all be suspected in patients with AUR under 40 years of age, as well as in patients with a history of urethritis, urethral foreign bodies and previous transurethral interventions or long-term catheterization of the bladder.
In this category of patients, as a rule, prostate enlargement is not detected, however, in some cases, stricture can be combined with BPH. To clarify the diagnosis, urethroscopy should be performed with a flexible cystourethroscope. If there is no technical ability to perform urethroscopy with a flexible cystourethroscope, ascending urethrography
.
Attempts at bladder catheterization in patients with suspected urethral stricture should begin with a 12 Fr Foley urethral catheter. If the thinnest catheter cannot be inserted into the bladder, attempts at catheterization should be stopped. Since the treatment of choice for urethral stricture is surgery, in cases of unsuccessful bladder catheterization, urinary diversion must be achieved by performing a cystostomy. Postoperative acute urinary retention
Most often, AUR is observed in patients who have undergone spinal or epidural anesthesia, extensive interventions on the abdominal, retroperitoneal and pelvic organs, as well as in patients receiving opioid analgesics.
AUR in the postoperative period can be both functional (after the use of epidural anesthesia and opioid analgesics) and organic in nature (after operations on the pelvic organs and retroperitoneal space). The type of postoperative AUR determines the duration of the period of restoration of independent urination, which can range from 6 weeks to 12 months. The main method of treating postoperative AUR is drainage of the bladder with a urethral catheter for 10-14 days. If there is no spontaneous urination after removal of the urethral catheter, bladder drainage can be accomplished by pure intermittent self-catheterization. For intermittent self-catheterization, it is necessary to use special disposable sterile catheters coated with a hydropolymer polyvinylpyrrolidone lubricant (Nelaton, male, female/children; various sizes (8-22 Fr). These catheters, upon contact with water, acquire a smooth, slippery surface, which significantly reduces friction with the mucous membrane urethra and minimizes the risk of developing traumatic injuries and infectious complications. Bladder tamponade
Bladder tamponade should be suspected in patients with a history of tumors of the kidney, pelvis, ureter or bladder and who have noted episodes of previous hematuria. Bladder tamponade often occurs in patients who have undergone surgery on the urinary tract, in patients with bleeding disorders and in patients taking anticoagulants.Treatment of AUR with tamponade should begin with drainage of the bladder with a urethral catheter, rinsing the bladder to light rinsing water and installing a flow-flushing system for continuous bladder irrigation .
For this purpose, it is necessary to use a three-way Foley catheter 22-24 Fr. If there is inadequate evacuation of blood clots using a urethral catheter, the clots can be removed endoscopically using an aspirator. If endoscopic bladder laundering is unsuccessful, the patient should undergo an open exploration of the bladder, removal of clots, and installation of a cystostomy drain. In order to relieve hematuria, all patients should be prescribed hemostatic therapy. It is preferable to use the following drugs: • tranexamic acid (Tranexam♠); • ethamsylate; • 10% calcium chloride solution. After eliminating bladder tamponade and AUR, an in-depth examination of patients should be performed to diagnose tumors of the kidney, pelvis, ureter and bladder. Acute urinary retention with a neurogenic bladder
should be suspected in patients suffering from concomitant diseases of the nervous system: • cerebral or spinal stroke;
• parkinsonism; • multiple sclerosis; • tumors of the brain and spinal cord; • traumatic brain injuries; • spinal injuries. A feature of the clinical course of AUR in patients with a neurogenic bladder is the non-sensory form of AUR, which is not accompanied by pain and the urge to urinate. Treatment of AUR in such patients should begin with bladder drainage with a urethral catheter. Further drainage of the bladder, after clarifying the diagnosis and determining the prognosis for the restoration of independent urination, should be performed either by intermittent self-catheterization or by suprapubic drainage. When treating patients with a neurogenic bladder, an integrated approach is required with the involvement of a neurologist or neurourologist. Acute urinary retention due to urinary tract injuries
In most cases, AUR due to urinary tract injuries occurs with injuries to the urethra and intraperitoneal rupture of the bladder.
The most common causes of injuries to the urethra and bladder: • blunt trauma to the abdomen; • pelvic bone fractures; • perineal injuries; • penile fractures. When AUR occurs against the background of the above injuries, the choice of method of bladder drainage is extremely important. Until urethral trauma has been ruled out, bladder catheterization is contraindicated. To exclude urethral trauma, all patients with suspected urethral trauma should undergo retrograde urethrography. If urethral injury cannot be ruled out, bladder drainage should be performed using the suprapubic method. Further treatment tactics are determined depending on the location, nature and extent of the damage. Acute urinary retention in acute prostatitis
In acute prostatitis, AUR develops due to severe swelling of the prostate gland.
The clinical picture, as a rule, is dominated by symptoms of dysuria and general intoxication. Pain in the perineum and lower abdomen, frequent painful urination, preceded by acute urination, fever, chills. There are episodes of frequent urination and urgency. In acute prostatitis, any transurethral interventions are contraindicated; drainage of the bladder until acute prostatitis is relieved should be carried out using cystostomy drainage. Acute urinary retention in women after surgery for urinary incontinence
AUR is a rare complication of surgeries performed for stress urinary incontinence.
If AUR occurs in the postoperative period, after removal of the urethral catheter, patients should undergo repeated catheterization of the bladder. The urethral catheter should be removed after 10-14 days. If urinary retention continues after catheter removal, further bladder drainage should be performed through intermittent self-catheterization. With frequent relapses of AUR, UTI and a significant deterioration in the patient’s quality of life due to difficulty urinating, it is necessary to consider the advisability of performing an operation to restore urethral patency, remove the sling, or urethrolysis. Acute urinary retention in patients with severe pelvic organ prolapse
In most patients with pelvic organ prolapse, independent urination is restored after reduction of the pelvic organs.
However, when they fall out again, the episode of AUR is repeated in the vast majority of cases. Since all patients in this group are indicated for surgical treatment of pelvic organ prolapse, prior to surgery, drainage of the bladder should be carried out with a urethral Foley catheter. If surgical correction of prolapse is not possible, wearing pessaries is indicated. Acute urinary retention with diverticula and urethral polyps
The cause of AUR in such patients is the presence of a mechanical obstruction to the outflow of urine in the form of a diverticulum or urethral polyp.
After removal of the urethral catheter in such patients, AUR recurs in most cases. Since all patients in this group are indicated for surgical excision of a polyp or urethral diverticulum, prior to surgery, drainage of the bladder should be carried out with a urethral catheter. If the patient is hospitalized in a highly specialized hospital, it is permissible to perform an emergency operation of transurethral resection or laser ablation of a urethral polyp
.

Other reasons for the development of shading

Postoperative complications.

Family doctors often suffer from stagnation of the blood after surgical interventions, in the development of which pain, trauma, excessive excess of blood flow and the use of drugs (especially narcotics) play a role. The frequency of development of the cut after surgery on the rectum can be 70% of cases, after prosthetics of the cervical tendon - 78%, after gynecological operations - 25% (Iorio R. et al., 2005; Hershberg er JM et al., 2003). The amount of bleeding after hemorrhoidectomy can be changed by replacing spinal anesthesia with selective pudendal block (Kim J. et al., 2005). Further research (GoNULLu NN et al., 1999) has shown that the incidence of cervical seizures in the postoperative period in humans can be reduced by administering prazosin in the perioperative period.

Shading of the section is associated with vaginosis.

The shading of the section during the hour of vacancy is primarily due to the compression of the internal meatus of the urethra to the position of the vaginal uterus in retroversion, most often focusing on the 16th gestation (Cardozo L. et al., 19 97). The frequency of development of shading after canopies falls to 1.7–17.9%, and the risk factors include first canopies, instrumental births, three-way canopies and cesarean roses (Glavind K. et al., 2003; Yip SK et al., 2005). Follow-up results Olofsson CI et al. (1997) in a study of more than 3,300 breeds demonstrated that wives that received epidural anesthesia exhibited a greater degree of decreased secrecy than those that were bred without such anesthesia.

Injury.

The shading of the cut can be caused by a severe urethral irritation, a member or a cut of the mikhur. The rupture of the urinary tract and the urethra are repaired in case of a fracture of the pelvic cysts or traumatic instrumental closure.

Diagnostic and clinical approach to a patient with a closed section

Tables 4 and 5 provide the basic principles for taking an anamnesis, physical examination and diagnostic algorithm for establishing the etiology of the cut.
Table 4. Establishment of the etiology of stabbing is based on the anamnesis and physical strain

Table 5. Constraint of patients due to section locking

Stressful and psychosomatic causes of urinary retention

The process of removing urine from the body may be disrupted due to temporary inhibition of the nervous system. Such conditions occur if:

• surgical intervention was performed in the peritoneum or pelvis;
• there was stress, psycho-emotional shock, fear;
• there is alcoholism;
• the patient has been lying down for a long time.

There are also medicinal factors for ischuria. Taking some antispasmodics, antiallergenic and other drugs can cause problems with urine output.

Regardless of the reasons for urine retention, this condition requires proper treatment. Ishuria leads to cystitis, pyelonephritis, stone formation, and kidney failure. If the bladder is distended, the consequence is paradoxical ischuria (uncontrolled urine output), which significantly impairs a person’s quality of life.

Common symptoms and manipulations in urology:

• Pain when urinating
• Discharge from the urethra
• Itching in the urethra
• Short frenulum of the foreskin
• Prostate massage
• Prevention of casual sex
• Frenum plastic surgery
• Circumcision
• Kidney pain
• Perineal pain
• Stones in the kidneys
• Pus in urine
• Catheter removal at home
• Bougienage of the urethra
• Urinary retention
• Urological examination
• Papillomas on the foreskin
• erectile disfunction
• Make an appointment with a urologist

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Author:

Kasabov Alexander Vladimirovich Urologist, Candidate of Medical Sciences, Ultrasound Doctor
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Benign prostatic hyperplasia

The most common cause of blockage is infravesical obstruction, called BPH. Patients are particularly likely to report symptoms on the side of the lower secundum, including frequent, difficult, intermittent secrecy, imperative positivity before secrecy, nocturia, weak secrecy, the presence of a pause Before the cob, the husk is released, in order to ensure that the husk is not properly emptied. There may be a mystery in the anterior catheterization in the anamnesis. Pay attention to the presence of provoking factors, such as alcohol abuse, recent surgery, thyroid infections, instrumental closure of the thyroid system, fasten, taking a large volume of radiation , refrigeration and increased prices. When taking an anamnesis, it is necessary to be careful about taking medications, especially those that can cause inflammation (Table 2).

Stiffening of the abdomen should include percussion and palpation of the cuticle. Sechovy mikhur can be detected by percussion, if you apply at least 150 ml of cut, and palpate - at least 200 ml of cut. To assess the size of the prostate, exclude prostate cancer and fecal impaction, perform a digital rectal scan. The detection of infection can be turned off with the help of an additional cross-sectional analysis. The volume of the excess section can be determined using additional ultrasound of the section fur (Fig. 1) or catheterization (after giving priority to the first method, it is non-invasive and allows you to eliminate the many complications, close ma infectious). The clinically significant volume of excess section, according to various authors, becomes 50 to 300 ml or more. The mother's trace is that during acute congestion, the PSA level increases significantly.

Rice. 1.

Ultrasound image of re-infused sawdust, which can be dispensed with more than 450 ml of cut.

Symptoms of urinary retention

There are acute and chronic forms of delayed urination. The symptoms in both cases will be different.

In acute forms of urine retention, the following are observed:

• painful cramps in the lower abdomen;
• swelling of the suprapubic region;
• intense urge to urinate.

This condition is life-threatening and requires emergency medical attention.

The chronic form is expressed by pain in the lumbar region, increased body temperature, increased urge to urinate, and chills. Upon palpation, you can find that the suprapubic area is enlarged, that is, the bladder is not completely emptied.

Useful information on the topic:

• Treatment of urinary retention
• Urinary retention in adults
• Urinary retention in pregnant women
• Urinary retention in women
• Urinary retention in men
• Acute urinary retention
• Chronic urinary retention
• Treatment of urinary retention at home
• Causes of urinary retention

Neurogenic sechovy mikhur

Another reason for shading, which family doctors often suffer from, is neurogenic rash. Patients may suffer from recurrent infections of the thyroid gland or ischuria paradoxa. When taking an anamnesis, you should pay attention to the presence of neurological illness, swelling or injury to the spinal cord, diabetes, as well as any change in neurological status. In patients suspected of having a neurogenic muscle fiber, it is necessary to carry out extra neurological restraint, as well as specific tests to assess the function of the muscle muscle: assessment of the bulbocavernosus reflex (bulcavernosus reflex) meat when squeezing the head of the penis), anal reflex (shortening of the anal sphincter when the skin is pricked ), the apparent shortening of the pelvic floor ulcers, the sensitivity of dermatotomes S2–S5 (Fig. 2), which are located in the perianal and “saddle-like” division. To eliminate swelling or other damage to the brain and spinal cord, there may be a need for visualization methods of fastening. If the presence of neurogenic sechovy mikhur is suspected, further tactics depend on the results of urodynamic fastening.

Rice. 2.

Dermatomy S2-S5.

Help with chronic form

In the chronic form, the patient is not always aware of the problem and fluid retention in the bladder. In such patients, urine is not released in full. The remaining fluid gradually stretches the walls of the bladder, which leads to urinary incontinence, and then to inflammation and pain.

Complete chronic urinary incontinence occurs in an advanced stage, when the patient is unable to empty the bladder.

Help in this case is as follows:

• catheterization for several days with the introduction of an anesthetic into the subcutaneous area of ​​the urethra;
• drug or surgical treatment of the main cause of urinary retention.

Self-medication is useless and has dangerous consequences.

Common symptoms and manipulations in urology:

• Pain when urinating
• Discharge from the urethra
• Itching in the urethra
• Short frenulum of the foreskin
• Prostate massage
• Prevention of casual sex
• Frenum plastic surgery
• Circumcision
• Kidney pain
• Perineal pain
• Stones in the kidneys
• Pus in urine
• Catheter removal at home
• Bougienage of the urethra
• Urinary retention
• Urological examination
• Papillomas on the foreskin
• erectile disfunction
• Make an appointment with a urologist