Sharp delay of an urination
Sharp delay of an urination – the pathological state caused by impossibility of depletion of a bladder. It is shown by pain in the bottom of a stomach and in the crotch irradiating to the area of genitals, strong concern of the patient. Diagnostics is made on the basis of data of the anamnesis, a clinical picture and complaints of the patient, results of survey (palpation), ultrasonography and endoscopic researches. Treatment includes a bladder kateterization, elimination of the reasons which caused an urine delay. The last can be made by both conservative, and surgical techniques.
Sharp delay of an urination
The Sharp Delay of an Urination (SDU), or ishuriya, is rather widespread state accompanying many urological diseases. About 85% of cases of pathology come to light at men 60 years suffering from a giperplaziya or adenoma of a prostate gland are more senior. According to data of medical statistics, the delay of urine develops approximately at 10% of people of this age category. More frequent emergence of a pathological state at males is caused by anatomic features – a long and narrow urethra. The isolated ishuriya forms (without existence of the main urological disease) are registered very seldom, can be provoked by neurogenetic, endocrine or other violations in an organism.
Reasons of a sharp delay of an urination
Unlike the chronic, gradually accruing ishuriya, the sharp delay is caused by rapid pathological process. In certain cases it arises as sudden interruption of a stream of urine during depletion. In total allocate several groups of the factors capable to lead to such phenomenon:
- Mechanical reasons. The delay of an urination develops because of a physical obstacle in urinary ways – concrements, clots of blood, tumor fragments. Sometimes it is noted against the background of prostatitis or adenoma of a prostate gland. The termination of outflow of urine is preceded by alcohol intake, spicy dishes, overcooling, causing rush of blood to pelvic bodies and prostate hypostasis.
- Psychosomatic factors. The emotional stress, especially in the presence of violations of mentality (neurosises, a psychopathia), is capable to oppress the reflexes responsible for an urination. Clinically it is shown by a sharp delay of release of urine.
- Post-traumatic states. Injuries of bodies of a basin, surgical interventions, childbirth can break an innervation of a bladder or urethra. As a result various frustration of an urination develop.
- Medicinal ishuriya. Reception of certain medicines (most often – hypnotic drugs, resolvents, antidepressants) at some persons provokes the spasms of urinary ways which are expressed a sudden full or partial delay of urine.
The central role in pathogenesis of OZM is played by overflow of a bladder at impossibility of its physiologic depletion. Most quicker there is a mechanical ishuriya – the urethra or an entrance to it is blocked by a stone, a blood clot, a foreign matter owing to what outflow of urine stops. This process is facilitated in the presence of already available narrowings of an urethra – , prostate gland giperplaziya. At damages of a prostate the sudden delay of outflow of urine is possible in case of its hypostasis – for example, at an exacerbation of prostatitis, violation of a diet at adenoma. Pathogenetic processes at psychosomatic, post-traumatic and dosage forms of a disease are quite difficult and have the multiple-factor nature. Most often there is a neurogenetic spasm of a gladkomyshechny cover of an urethra or sphincter of a bladder.
Symptoms of a sharp delay of an urination
Clinical picture of pathology rather specific and obvious. Usually sharp state is preceded by displays of the main disease – an urolitiaz, damages of a prostate, urethras. Patients with OZM, are uneasy, cannot remain sitting on one place, often adopt the halfbent provision. The main complaints are impossibility of depletion of a bladder, despite the strongest desires, pain in the field of a pubis and a crotch. Morbidity and feeling of a raspiraniye in a stomach sharply amplify when pressing a little above a pubic simfiz. Symptoms develop within several hours.
Sometimes the beginning of a disease especially sharp – during an urination a liquid stream sharply is interrupted then release of urine stops. It demonstrates that the concrement or a clot of blood which blocked an urethra gleam served as the reason of pathology. Duration of a delay can make from several hours to several days. In most cases outflow of urine results only from medical manipulations – kateterization or tsistostomiya. Extremely seldom sharp ishuriya stops spontaneously – for example, in case of a stone exit outside or its shifts from area of a neck of a bubble.
Any type of a delay of an urination becomes the reason of accumulation of liquid and increase in pressure in urinary tract. A result of it is the return movement of liquid (from a bubble – in mochetochnik and lokhanka) that can lead to their infection. In hard cases pressure of urine reaches such size that provokes or emergence of a diverticulum of a bladder. Sometimes the delay of urine becomes the reason of a sharp renal failure. A recurrence of pathology facilitates development of infectious and inflammatory diseases of an urinary system – cystitis and pyelonephritises. Sharp process in some cases is capable to pass into a chronic form, to cause education an urethra and other urological pathologies.
In urology there is a set of techniques for definition of existence and an etiology of a sharp delay of an urination. Usually diagnosis of an ishuriya does not cause difficulties, is carried out at a stage of survey of the doctor-urologist. Other researches are more directed to clarification of the reasons of this state that is necessary for development of etiotropny treatment and prevention of a recurrence. Diagnostic techniques are divided into the following groups:
- Survey and collecting anamnesis. The patient's bespokoynost, frequent change of position of a body attracts attention. Over a lonny joint protrusion is found in thin patients, at percussion the stupid sound is defined. The palpation is painful, in its course roundish elastic education in nadlobkovy area is probed. In the anamnesis quite often there are urological diseases or injuries.
- Ultrasonography of a bladder and urethra. At ultrasonography the body overflowed with liquid is registered. Besides, it is possible to define the possible reason of an ishuriya by this technique – increase in a prostate, existence of concrements in a neck of a bubble or an urethra.
- Uretrotsistoskopiya. At mechanical character of a delay of urine endoscopy is used as a medical and diagnostic technique. With its help it is possible not only to find overlapping of urinary tract, but also to eliminate it (litoekstraktion).
In some cases carry out additional diagnostic actions, for example, appoint consultation of the neurologist or psychiatrist at suspicion to a psychosomatic ishuriya. Differential diagnostics should be carried out with an anury – lack of formation of urine. At the same time the urination does not occur in the absence of desires, at survey the crowded bladder is not defined. Besides, the anury is almost always combined with manifestations of OPN – an ammonia smell from a mouth, the general serious condition of the patient.
Treatment of a sharp delay of an urination
All medical actions at a sharp ishuriya divide on urgent or emergency and etiotropny. The first are necessary for elimination of the main display of pathology – impossibility of release of urine. Apply several methods to restoration of an urodinamika, the choice of the concrete equipment depends on the reasons of pathology and a condition of the patient. Most often for this purpose carry out the following manipulations:
- Kateterization of a bladder. Is the most widespread method of ensuring outflow of urine at various forms of an ishuriya. Relative simplicity and reliability are considered as advantages of the equipment. Statement of a catheter is contraindicated at the "driven" concrements, sharp inflammatory pathologies of an urethra and prostate gland,
- Nadlobkovy tsistostomiya. The surgical technique providing outflow of urine through the tube established in a bubble wall section. It is carried out at impossibility of an intrauretralny kateterization.
- Conservative methods. If the ishuriya has neurogenetic or psychosomatic character, it is possible to restore a normal urodinamika by means of irrigation of genitals warm water. At inefficiency of this equipment apply subcutaneous injections M-holinomimetikov. Sometimes release of urine is stimulated with introduction to an urethra of small amounts of solution of novocaine.
Etiotropny treatment of a delay of an urination can include removal of stones, surgical or medicinal therapy of diseases of a prostate gland, reception of sedative medicines. If the ishuriya is provoked by use of antidepressants, sleeping medicines – their cancellation or correction of a dosage and regular observation at the urologist is necessary.
Forecast and prevention
In most cases the forecast of OZM favorable, when providing a normal otkhozhdeniye of urine of life and to health of the patient threatens nothing. The probability of a recurrence and long-term prospects of a disease depend on its reasons – at an urolitiaza the ishuriya is often presented by a single episode, and at prostatitis periodically etsyatsya during the periods an aggravation of inflammatory process. Prevention of pathology consists in timely treatment of urological states – an urolithic disease, damages of a prostate, hemorrhagic cystitis, urethras. On condition of their elimination or control from the patient and experts the probability of a pathological delay of urine repeatedly decreases.