January, 29th 2015

URINARY RETENTION AND

CATHETERIZATION
Nama

: Anasti Putri Paramatsari

NIM

: 030.10.028

Pembimbing : dr. Bagus, Sp. BU

Kepaniteraan Klinik Bagian Ilmu Bedah

Sub Departement Bedah Urologi
Rumah Sakit Umum Bekasi
5 Januari 14 Maret 2015

TOPIK BAHASAN

TOPIK
BAHASAN
Definisi
Prevalensi
dan Insidensi

Komplikasi

Kateterisasi
Urethral

Tatalaksana

Retentio
Urine

Pemeriksaan
Penunjang

Etiologi

Anatomi dan
Fisiologi

Patofisiologi
Manifestasi
Klinis

DEFINITION

DEFINISI
Urinary retention is the inability to
voluntarily urinate.
Acute urinary retention is the sudden and
often painful inability to void despite having
a full bladder.1
Chronic urinary retention is painless
retention associated with an increased volume
of residual urine.2

1.
2.

Rosenstein D, McAninch JW. Urologic Emergencies. Med Clin North Am. 2004;88(2):495518.
Deane AM, Worth PH. Female chronic urinary retention. Br J Urol. 1985;57(1):2426.

PREVALENSI AND
INCIDENSI

PREVALENSI AND INSIDENSI

Pada pria berusia 43 80 tahun, insidensi dari

urinary retention 4.5 sampai 6.8 per 1,000 pria.3
Pada pria berusia 70-an, insidensi dari urinary
retention meningkat sampai 100 per 1,000 pria. 3
Pada pria berusia 80-an, insidensi dari urinary
retention meningkat sampai 300 per 1,000 pria. 3
Urinary retention pada wanita lebih sedikit
dibandingkan pria, meskipun juga tidak jarang. 4

3. Sellius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. American Family
Physician. 20008;77(5):643-650.
4. Wein Aj, Kavoussi LR, Noviick AC, et al. CampbellWalsh Urology. 10 th ed. Philadelphia: Saunders; 2011
p. 157-8.

ETIOLOGI

ETIOLOG
I
Obstruksi

Infeksi dan
Peradangan

Lain-lain

Etiologi

Neurologis

Farmacologist
Agent

ETIOLOGI(2)
Selected Causes of Urinary Retention1,4, 6-8
Causes

Men
Benign prostatic hyperplasia;

Obstructive

Women
Organ prolapse (cystocele,

Both
Aneurysmal dilation; bladder

meatal stenosis; paraphimosis; rectocele, uterine prolapse);

calculi; bladder neoplasm; fecal

penile constricting bands;

pelvic mass (gynecologic

impaction; gastrointestinal or

phimosis; prostate cancer

malignancy, uterine fibroid,

retroperitoneal

ovarian cyst); retroverted

malignancy/mass; urethral

impacted gravid uterus

strictures, foreign bodies,

stones, edema

Balanitis; prostatic abscess;

Acute vulvovaginitis; vaginal

Bilharziasis; cystitis;

prostatitis

lichen planus; vaginal lichen

echinococcosis; Guillain-Barr

sclerosis; vaginal pemphigus

syndrome; herpes simplex

Infectious and

virus; Lyme disease;

periurethral abscess;

inflammatory

transverses myelitis; tubercular

cystitis; urethritis; varicellazoster virus

Other

Penile trauma, fracture, or

Postpartum complication;

laceration

urethral sphincter dysfunction and bladder neck in pelvic

(Fowler's syndrome)

Disruption of posterior urethra

trauma; postoperative
complication; psychogenic

ETIOLOGI(3)
Pharmacologic Agents Associated with Urinary Retention 8

Class
Antiarrhythmics

Drugs
Disopyramide (Norpace); procainamide (Pronestyl); quinidine
Atropine (Atreza); belladonna alkaloids; dicyclomine (Bentyl);
flavoxate (Urispas); glycopyrrolate (Robinul); hyoscyamine

Anticholinergics (selected)

Antidepressants
Antihistamines (selected)
Antihypertensives
Antiparkinsonian agents

(Levsin); oxybutynin (Ditropan); propantheline (ProBanthine*); scopolamine (Transderm Scop)

Amitriptyline (Elavil*); amoxapine; doxepin (Sinequan*);

imipramine (Tofranil); maprotiline (Ludiomil*); nortriptyline
(Pamelor)
Brompheniramine (Brovex); chlorpheniramine (ChlorTrimeton); cyproheptadine (Periactin*); diphenhydramine
(Benadryl); hydroxyzine (Atarax*)
Hydralazine; nifedipine (Procardia)
Amantadine (Symmetrel); benztropine (Cogentin);
bromocriptine (Parlodel); levodopa (Larodopa*);
trihexyphenidyl (Artane*)

ETIOLOGI(4)
Pharmacologic Agents (lanjutan)
Antipsychotics

Chlorpromazine (Thorazine*); fluphenazine

(Prolixin*); haloperidol (Haldol); prochlorperazine
(Compazine*); thioridazine (Mellaril*); thiothixene
(Navane)

Hormonal agents

Estrogen; progesterone; testosterone

Muscle relaxants

Baclofen (Lioresal); cyclobenzaprine (Flexeril); diazepam

Sympathomimetics (alpha-

Ephedrine; phenylephrine (Neo-Synephrine);

adrenergic agents)
Sympathomimetics (betaadrenergic agents)
Miscellaneous

(Valium)
phenylpropanolamine; pseudoephedrine (Sudafed)

Isoproterenol (Isuprel); metaproterenol (Alupent);

terbutaline (Brethine*)

Amphetamines; carbamazepine (Tegretol); dopamine

(Intropin*); mercurial diuretics; nonsteroidal anti-

drugs (e.g., indomethacin [Indocin]); opioid

8. Choong S, Emberton M. Acute urinary retention. inflammatory
BJU Int. 2000;85(2):186201.
analgesics (e.g., morphine [Duramorph]); vincristine
(Vincasar PFS)

ETIOLOGI(5)
Neurologic Causes of Urinary Retention and Voiding Dysfunction9

Lesion Type

Causes
Autonomic neuropathy; diabetes mellitus; Guillain-

Autonomic or peripheral nerve

Barr syndrome; herpes zoster virus; Lyme disease;

pernicious anemia; poliomyelitis; radical pelvic
surgery; sacral agenesis; spinal cord trauma; tabes
dorsalis
Cerebrovascular disease; concussion; multiple

Brain

sclerosis; neoplasm or tumor; normal pressure

hydrocephalus; Parkinson's disease; Shy-Drager
syndrome
Dysraphic lesions; invertebral disk disease;
meningomyelocele; multiple sclerosis; spina bifida

Spinal cord

occulta; spinal cord hematoma or abscess; spinal

cord trauma; spinal stenosis; spinovascular disease;

transverse myelitis; tumors or masses of conus

9. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence.
medullaris or cauda equine
Emerg Med Clin North Am. 2001;19(3):600.

ETIOLOGI(5)

Other
Causes

Postoperative Complications:
Pain; Traumatic instrumentation; Bladder over-distension;
Pharmacologic agents; Selective pudendal nerve block.10-14

Pregnancy-Associated Urinary Retention:

During pregnancy is usually the result of an impacted retroverted
uterus that causes obstruction of the internal urethral meatus, most
often at 16 weeks' gestation; 15
Post-partum who received epidural anesthesia were significantly
more likely to experience urinary retention.15
Trauma:
Acute injury to the urethra, penis, or bladder may cause urinary
retention; bladder rupture and urethral disruption can occur
with pelvic fracture or traumatic instrumentation.16

ANATOMI DAN FISIOLOGI

ANATOMI

ANATOMI (2)

FISIOLOGI

FISIOLOGI(2)

FISIOLOGI(3)

Stage of Micturition

Bladder
filling

Bladder
emptying

Voiding
phase

FISIOLOGI(3)

FISIOLOGI(4)

FISIOLOGI(5)

FISIOLOGI(6)

Steps of micturition
(voiding phase)
Bladder fills progresively
Tension bladder wall increase
Initiate a nervous reflex
Micturition reflex: empties the bladder
and causes conscious desire to urinate
Autonomic spinal cord reflex:
inhibited/facilitated by centers in brain
stem and cerebral cortex

FISIOLOGI(7)

Nerve Supply
Sympathetic Nerve
N. Hypogastricus (L1-L3)
Bladder wall relaxation
M. sphincter urethra interna contraction
Parasympathetic Nerve
Pelvic nerve (S2-S4)
Bladder wall contraction
M. sphincter urethra interna relaxation
Somatic
N. Pudenddus (S2-S4)
Acts on sphincter urethra externa

FISIOLOGI(7)

MANIFESTASI KLINIS

SYMPTOMS

Acute urinary retention:

inability

to urinate (anuria)
painful, urgent need to urinate (urgency)
pain or discomfort in the lower abdomen
bloating of the lower abdomen.

Chronic urinary retention:

urinary

frequency (urination eight or more times a day)

trouble beginning a urine stream
a weak or an interrupted urine stream
an urgent need to urinate with little success when trying to
urinate
feeling the need to urinate after finishing urination
mild and constant discomfort in the lower abdomen and urinary
tract.

PEMERIKSAAN
FISIK
Umumnya keadaan umum dan tanda vital dalam batas
normal. Dapat terjadi perubahan akibat adanya nyeri hebat.
Abdomen:

Inspeksi:

tidak tampak kelainan, terlihat tegang atau menonjol di

regio suprapubik.
Auskultasi: tidak tampak kelainan
Palpasi: teraba masa di regio suprapubik, bentuk bulat, tepi tidak
tegas, permukaan rata, konsistensi kenyal, tidak dapat
digerakkan, nyeri tekan dapat +; palpasi bimanual ginjal dapat
teraba masa.
Perkusi: nyeri ketok +

Pemeriksaan genitalia eksterna

Rectal toucher dan pemeriksaan bimanual vesika
urinaria.
Pemeriksaan neurologi

Possible Etiology of Urinary Retention Based on History and

Physical Examination Findings17-20

17.Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am.
2001;19(3):591619.
18. Ellerkmann RM, McBride A. Management of obstructive voiding dysfunction. Drugs Today (Barc). 2003;39(7):513540.
19. Dorflinger A, Monga A. Voiding dysfunction. Curr Opin Obstet Gynecol. 2001;13(5):507512.
20. Stohrer M, Goepel M, Kondo A, et al. The standardization of terminology in neurogenic lower urinary tract
dysfunction: with suggestions for diagnostic procedures. International Continence Society Standardization
Committee. Neurourol Urodyn . 1999;18(2):139158.

PEMERIKSAAN PENUNJANG

PEMERIKSAAN PENUNJANG17-20
Laboratory
Urinalysis: evaluate for infection, hematuria, proteinuria, glucosuria
Serum BUN, creatinine, electrolytes: evaluate for renal failure from lower UTI
Serum blood glucose: evaluate for undiagnosed or uncontrolled DM in neurogenic
bladder.
Prostate-specific antigen: elevated in prostate cancer, may be elevated in BPH,
prostatitis, and in the setting of AUR
Imaging Studies
Renal and bladder USG: measure postvoid residual urine; evaluate for bladder and
urethral stones, hydronephrosis, and upper urinary tract disease.
Pelvic USG, CT of abdomen and pelvic: evaluate for suspected pelvic, abdominal or
retroperitoneal mass or malignancy causing extrinsic bladder neck compression.
MRI or CT of brain: evaluate for intracranial lesion, including tumor, stroke,
multiple sclerosis (MRI preferred in MS)
MRI of spine: evaluate for lumbosacral disk herniation, cauda eqquina syndrome,
spinal tumors, spinal cord compression, MS.
Other
Cystoscopy, retrograde cystourethrography: evaluate for suspected bladder tumor
and bladder or urethral stones or strictures.
Urodynamic studies (e.g., uroflowmetry, cystometry, electromyography, urethral
pressure profile): evaluate bladder function (detrusoor muscle and sphincter) in patiens
with neurogenic ladder to help guide management.

TATALAKSANA

TATALAKSAN
A

Urinary retention:

bladder drainage
urethral dilatation
causal treatment, e.g., prostate medication
Surgery
Administered consultation

Acute urinary retention:

immediate and complete decompression of the bladder through

catheterization, if catheter placement is not successful, a suprapubic tube
should be placed approximately two finger breadths above the pubic
symphysis.

For BPH: a coude (French for curved) catheter is helpful in

negotiating past the angulation in the prostatic urethra. The curved
portion (which is angled in line with the balloon port) is maintained
at the 12 o'clock position as it is passed through the urethra.22
For stricture: using a 12F or 14F catheter often will allow the
passage of the catheter into the bladder. 22

TATALAKSAN
A

KATETERISASI URETHA

DEFINISI
Kateter adalah sebuah alat berbentuk pipa yang
dimasukkan ke dalam kandung kemih dengan
tujuan untuk mengeluarkan urine yang terdapat
di dalamnya.
Kateterisasi
urethra
adalah
tindakan
memasukkan selang karet atau plastik melalui
uretra ke dalam kandung kemih untuk
mengeluarkan urine

INDIKASI

Diagnostik:

Memperoleh

contoh urin pada wanita guna pemeriksaan kultur

urin.
Mengukur residual urin pada pembesaran prostat.
Memasukkan bahan kontras pemeriksaan seperti pada sistogram.
Mengukur tekanan tekanan buli-buli seperti pada sindrom
kompartemen abdomen.
Mengukur produksi urin yang merupakan cerminan keadaan
perfusi ginjal pada penderita shock
Mengetahui perbaikan atau perburukan pada trauma ginjal.

Terapeutik:

Mengeluarkan

urin pada retensio urinae

Membilas / irigasi buli-buli setelah operasi batu buli-buli, tumor
buli atau prostat
Sebagai splint setelah operasi uretra seperti pada hipospadia
Untuk memasukkan obat ke buli-buli, misalnya pada carcinoma
buli-buli.

KONTRAINDIK
ASI

Absolute

Rupture

Relative

Striktur

urethra

uretra
Pembedahan uretra atau bladder,
Pada pasien yang tidak kooperatif.

JENIS KATETER
Kateter Nelathon/ kateter straight/ kateter
sementara: kateter urin yang berguna untuk
mengeluarkan urin sementara atau sesaat.
Kateter
balon/kateter
Folley,
Kateter
Indwelling/ Kateter Tetap: kateter yang
digunakan untuk mengeluarkan urin dalam
sistem tertutup dan bebas hama, dapat
digunakan untuk waktu lebih lama (5 hari).
Kateter suprapubik dengan bungkus Silver
alloy: kateter yang dibungkus dengan perak
bagian luar maupun bagian dalamnya.

UKURAN
KATETER
Wanita dewasa : no 14/16
Laki-laki dewasa : no 18/20
Anak-anak : no 8/10

ALAT DAN
BAHAN

Kateter urin
Urin bag
Sarung tangan steril
Set bengkok dan pinset steril
Kapas dan cairan sublimate
Jelly
Plester
Perban
Spuit dan Steril water aquadest
Bengkok tidak steril
Alas/ Perlak kecil
Handuk kecil + Waskom isi air hangat + sabun
Sampiran
Lampu

TINDAKAN
PELAKSANAAN
1. Identifikasi pasien
2. Jelaskan prosedur kepada pasien
3. Tarik tirai tempat tidur dan atur posisi
a. Pasien anak/pasien sadar butuh bantuan
b. Pasien dewasa/wanita : posisi dorsal recumbent dengan lutut fleksi
c. Pasien dewasa/ laki-laki: Posisi supine dan kaki abduksi
4. Pasang urin bag
5. Pasang perlak atau alas pada klien
6. Tuangkan cairan antiseptic
7. Sediakan spuit isi aquadest
8. Cuci tangan dengan cara furbringer
9. Pasang sarung tangan
10. Lakukan vulva/perineum hygiene
11. Buka set kateter dan berikan jelly di ujung kateter
12. Masukkan kateter sampai urin mengalir
13. Ketika urin mengalir, pindahkan tangan yang tidak dominant dari labia atau dari penis ke
kateter.
14. Jika menggunakan indwelling kateter, isi balon kemudian tarik kateter 2,5 cm
15. Fiksasi kateter
16. Bantu pasien pada posisi yang nyaman
17. Kumpulkan dan buang alat-alat yang sekali pakai, bersihkan alat-alat yang bukan sekali pakai
18. Cuci tangan.

KOMPLIKASI

KOMPLIKAS
I

Complications of urinary retention and its

treatment:
UTIs

bladder

damage
kidney damage
urinary incontinence after surgery

DAFTAR PUSTAKA

DAFTAR
PUSTAKA
1.

Rosenstein D, McAninch JW. Urologic Emergencies. Med Clin North Am.

2004;88(2):495518.

2.

Deane AM, Worth PH. Female chronic urinary retention. Br J Urol. 1985;57(1):24
26.

3.

Sellius BA, Subedi R. Urinary retention in adults: diagnosis and initial

management. American Family Physician. 20008;77(5):643-650.

4.

Wein Aj, Kavoussi LR, Noviick AC, et al. CampbellWalsh Urology. 10th ed.
Philadelphia: Saunders; 2011 p. 157-8.

5.

Meigs JB, Barry MJ, Giovannucci E, Rimm EB, Stampfer MJ, Kawachi I. Incidence
rates and risk factors for acute urinary retention: the health professionals follow up
study. J Urol. 1999;162(2):376382.

6.

Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary
incontinence. Emerg Med Clin North Am. 2001;19(3):591619.

7.

Ellerkmann RM, McBride A. Management of obstructive voiding dysfunction.

Drugs Today (Barc). 2003;39(7):513540.

8.

Choong S, Emberton M. Acute urinary retention. BJU Int. 2000;85(2):186201.

9.

Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary
incontinence. Emerg Med Clin North Am. 2001;19(3):600.

10.

Kim J, Lee DS, Jang SM, Shim MC, Jee DL. The effect of pudendal block on
voiding after hemorrhoidectomy. Dis Colon Rectum. 2005;48(3):518523.

DAFTAR PUSTAKA
11.

Iorio R, Whang W, Healy WL, Patch DA, Najibi S, Appleby D. The utility of bladder
catheterization in total hip arthroplasty. Clin Orthop Relat Res . 2005;(432):148152.

12.

Hershberger JM, Milad MP. A randomized clinical trial of lorazepam for the reduction of
postoperative urinary retention. Obstet Gynecol. 2003;102(2):311316.

13.

Gonullu NN, Dulger M, Utkan NZ, Canturk NZ, Alponat A. Prevention of postherniorrhaphy
urinary retention with prazosin. Am Surg . 1999;65(1):5558.

14.

Cardozo L, Cutner A. Lower urinary tract symptoms in pregnancy. Br J Urol. 1997;80(suppl

1):1423.

15.

Glavind K, Bjork J. Incidence and treatment of urinary retention post-partum. Int Urogynecol J
Pelvic Floor Dysfunct . 2003;14(2):119121.

16.

Yip SK, Sahota D, Pang MW, Day L. Postpartum urinary retention. Obstet Gynecol.
2005;106(3):602606.

17.

Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg
Med Clin North Am . 2001;19(3):591619.

18.

Ellerkmann RM, McBride A. Management of obstructive voiding dysfunction. Drugs Today

(Barc). 2003;39(7):513540.

19.

Dorflinger A, Monga A. Voiding dysfunction. Curr Opin Obstet Gynecol. 2001;13(5):507512.

20.

Stohrer M, Goepel M, Kondo A, et al. The standardization of terminology in neurogenic lower

urinary tract dysfunction: with suggestions for diagnostic procedures. International Continence
Society Standardization Committee. Neurourol Urodyn . 1999;18(2):139158.

TERIMA KASIH