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Third, the emergency situation caused by urinary tract obstruction(A) of the urinary bladder more difficult and more acute obstruction caused by the stones, stones in the urinary tract are discussed in the section; bladder following obstruction caused difficulties in urinating, or can not urinate, is the most common urological emergency situation. As in older men with benign prostatic hyperplasia; as urethral trauma or urethritis, especially gonococcal urethritis, caused by improper treatment of dysuria and urethral stricture is a common emergency. The symptoms can not urinate for the past, sometimes referred to as "urinate", This is caused by the kidney disease itself, "no urine" easy to be confused, which is not the formation of urine, while the former is a function of the kidney there is the formation of urine, but urinary can not be discharged in the bladder, called "urinary retention" may be more accurate.(B) benign prostatic hyperplasia occurred in the 50 years of age, the middle and lateral lobe of the prostate gland, connective tissue and smooth muscle hyperplasia and gradual formation of multiple spherical nodules, gradually after the urethral obstruction. Early on, patients can not urinate immediately discharged, gradually forced to wait some time to discharge, thin and weak urinary stream, a short range. When the continued growth of nodular hyperplasia, urethral obstruction is more obvious, even more effort this time uri


nation, the urine of bladder emptying can not be one, to be discharged by several segments, and often not the feeling of urination. Not completely emptying the bladder, the presence of residual urine in the bladder capacity of less effective, and because patients with bladder neck and trigone mucosa often congestion and stimulate the bladder tension, increased urination, frequent urination and urinary urgency, urinary times increased attention more easily at night, the patient complained nocturia increased. In the later period, the urine can not be a line, and was dribbling like, at this time actually had chronic urinary retention, bladder residual urine volume is quite large, sometimes excessive expansion of the bladder, the internal pressure is high, the urine is free to overflow, as false urinary incontinence. The poor drainage of urine, easy to lead to infection, inflammation, so that the bladder neck and posterior urethral mucosal edema, congestion, and further can not increase the excretion of urinary obstruction leaving as acute urinary retention.(C) of the Department of urethral stricture and more long-term treatment of chronic post-traumatic inflammation or improper. How to deal with urethral trauma, see Chapter 66. Gonococcal urethritis, disappeared 30 years in China, the current increase in the incidence of potential there. If not completely in the acute phase of treatment, due to violations of long urethral gonococcal mucosa, consequent formation of a long narrow, treatment more difficult. The main symptoms of urethral stricture voiding difficulty, effort, and as poor drainage, there appear secondary to inflammation, inflammation of the fibrous tissue can gradually narrow the development, while the urethral mucosa congestion, edema and increased the degree of obstruction, it will also acute urinary retention.Fourth, clinical manifestationsPatients in the emergency department with acute urinary retention, the expression is extremely painful, history may indicate the cause of disease. Examination shows abdominal distension, percussion is voiced, sometimes up to the end of the bladder umbilical plane. Check the penis, urethra and urethral strips with or without hard claim was to exclude urethral stricture scar tissue. Digital rectal examination can be touched to know the size of the prostate, normal prostate shape of a chestnut, and pointed end down in the bottom diameter of about 4cm, longitudinal diameter of 3cm, the anteroposterior diameter of 2cm, which may be palpable on both sides of a depression between leaf , called the central sulcus. When prostatic hyperplasia, not only gland increases, the central sulcus is also shallow level. In acute urinary retention, the subject of the bladder fullness, often touch the prostate than its actual size to be larger. Should try to empty the bladder, the prostate check again, check whether the real increase in order to avoid diagnostic errors.Should take into account the possibility of neurogenic bladder, a detailed neurological examination is necessary. Some drugs, such as anti-histamine medicines phenothiazines, medicines such as the ganglion block guanethidine, reserpine, anticholinergic drugs such as Propantheline, in some patients also caused voiding dysfunction, or urinary retention. In elderly patients, the prostate may have increased, these drugs may induce acute urinary retention.When in acute urinary retention, bladder distension, abnormal pain patients should first lift the urine retention. The most common method is sterile operation, try put a rubber catheter from the urethra. Obstruction caused by benign prostatic hyperplasia, when the urethral catheter after the front end to feel resistance, the little thrust, can generally be approved. The urethral stricture scar tissue is hard and not as smooth, especially in the narrow scars caused by trauma, injury ends of the urethra is difficult when there is dislocation of the catheter through the rubber. Rubber catheter usually can not be obstruction, for metal catheter. Not received professional training for physicians urology should be very careful, otherwise not only can not be obstructive, but cause more trauma. When using a metal catheter should not be smaller than the Fr.16 number, too small and the metal catheter at the puncture in the obstruction of the urethra and the formation of false passage, so that subsequent processing more difficult. There is a glial catheter, between the metal and rubber hardness between the tip and gradually smaller, and made a variety of angles in the front, making it easy through the site of obstruction.If the catheter through the obstruction into the bladder, urinary retention can be discharged, a temporary solution to the suffering of patients, routine laboratory tests and urine bacterial cultures sent. Through expansion of the bladder, the drainage to slow and avoid the pressure of the bladder caused by a sudden decrease bleeding. Catheter into the bladder, do not easily withdrawn, as the primary lesion caused by obstruction has not yet been treated, once again the possibility of the formation of urinary retention significantly. Should be retained in the bladder catheter, to be fixed in the external urethral orifice.Such as catheter obstruction can not be the lower abdomen through the skin puncture the bladder. As the bladder is fullness, covering the anterior wall of the bladder has been pushed up the upper part of the peritoneum, abdominal swelling of the bladder is located directly under the puncture is safe. As a rule the lower abdomen skin after sterilization, sterile shop towels, the operator wearing sterile gloves, the middle of the lower abdomen, pubic symphysis at the upper edge of 3 ~ 4cm, local infiltration of 0.5% ~ 1.0% novocaine anesthesia, using ordinary 20, lumbar puncture needle, puncture the bladder directly through the skin, suck out the urine. Needle can not be retained, so the best use of trocar puncture, and then through the casing into the thin rubber catheter, to maintain the drainage. New catheter needle was placed in the cavity close to the core needle catheter, puncture, core needle out, leaving catheter in the bladder. Catheter thick, enabling drainage.If the existence of benign prostatic hyperplasia has been a long time, and has affected the renal function, patients do not allow the situation prostatectomy surgery, while in the emergency department is a permanent suprapubic cystostomy. Such as benign prostatic hyperplasia with acute urinary retention, and body in good condition can be checked if necessary for emergency prostate surgery, may resectoscope for transurethral prostate surgery electricity. However, elective surgery is still safe.Transurethral resection of prostate hyperplasia, the method is simple, less invasive, old and infirm who are more able to tolerate. Postoperative indwelling urethral catheter as long as 1 to 3 days.Urethral stricture occurred due to acute urinary retention, such as stenosis may be repaired by surgery can be as bladder puncture, suprapubic catheter retention, after re-repair surgery. Such as the narrow part of the long, after repeated unsuccessful surgical repair, may also consider a permanent suprapubic cystostomy. In the case of anterior urethral stricture, urethral perineal skin is also possible colostomy.
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