Last reviewed: 3 Feb 2021
Last updated: 09 Feb 2021
Summary
Definition
History and exam
Key diagnostic factors
- signs of early organ dysfunction (tachypnea, tachycardia, hypotension, altered mental state) in a patient with suspected sepsis
- flank pain
- fever
- lower urinary tract symptoms
- distended abdomen/palpable bladder
- inability to urinate
- enlarged or hard nodular prostate on rectal examination
- costovertebral angle tenderness
- neurologic disease (e.g., spinal cord injury, multiple sclerosis)
Other diagnostic factors
- hematuria
- increasing age
- meatal narrowing
- pelvic or abdominal malignancy
- previous urethral instrumentation
- urinary tract infection in a child
- pelvic mass on internal examination
- weight loss and lymphadenopathy
- recurrent urinary tract infections
- urinary incontinence
Risk factors
- benign prostatic hyperplasia (BPH)
- constipation
- medication (anticholinergic agents, narcotic analgesia, alpha receptor agonists)
- urolithiasis (ureteric calculi)
- spinal cord injury, Parkinson disease, or multiple sclerosis
- malignancy
- pregnancy
- hematuria
- posterior urethral valves
- bladder hernia
- cystocele
- iatrogenic injury
- urethral instrumentation
- retroperitoneal fibrosis
- meatal stenosis
Diagnostic investigations
1st investigations to order
- urinary dipstick
- renal ultrasound
- serum BUN and creatinine
- CBC
- CT pyelogram
- intravenous pyelogram (excretory urography)
Investigations to consider
- urine culture
- blood culture
- CT scan abdomen and pelvis
- magnetic resonance urography
- nuclear renography (triple renal/MAG3 scan)
- voiding cystourethrogram
- bladder ultrasound
- prostate specific antigen
- tumor markers (e.g., serum carcinoembryonic antigen [CEA], CA125)
Treatment algorithm
Contributors
Authors
Urologist
Integrative Health Matters
TylerÂ
TX
Disclosures
AJC declares that she has no competing interests.
Peer reviewers
Private Practice Urologist
Asheville
NC
Disclosures
BC declares that he has no competing interests.
Private Practice Urologist
Miami
FL
Disclosures
YS declares that he has no competing interests.
Lecturer in Uro-oncology and Consultant Urological Surgeon
Department of Urology
Addenbrooke's Hospital
Cambridge
UK
Disclosures
VG declares that he has no competing interests.
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