ELDER TIP As a person ages, his bladder muscles weaken, which may result in incomplete bladder emptying and chronic urine retention — factors that predispose the older person to bladder infections.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Anuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute tubular necrosis
Oliguria (occasionally anuria) is a common finding in acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral)
Cortical necrosis is characterized by a sudden change from oliguria to anuria along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute)
Glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He may also show signs of upper respiratory tract infection.
Papillary necrosis (acute)
Bilateral papillary necrosis produces anuria or oliguria as well as flank pain, costovertebral angle tenderness, renal colic, abdominal pain and rigidity, fever, vomiting, decreased bowel sounds, hematuria, and pyuria.
Renal artery occlusion (bilateral)
Renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli—a common complication—produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub, and possibly hemoptysis.
Urinary tract obstruction
Severe obstruction can produce acute and sometimes total anuria alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis
Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmias, pallor, and possibly skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Bladder distention:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
In BPH, bladder distention develops gradually as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but pain is usually the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It’s usually most severe when micturition ceases. The pain may be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Cultural Cue: Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
In this neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. In some patients, urine retention and bladder distention are the only signs.
Cultural Cue: Prostate cancer is more common in Blacks than in other ethnic groups.
Prostatitis
In acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and a sensation of suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Bladder distention is rare in chronic prostatitis, which may be accompanied by perineal discomfort, a sensation of suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that often mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
In urethral calculi, urethral obstruction leads to interrupted urine flow and bladder distention. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation due to catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In this predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cultural Cue: Bladder cancer is twice as common in White males as in Blacks. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. In chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. In viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Gender Cue: Women are more prone to develop cystitis than men because they have a shorter urethra. For men, age is a factor: Older men have a 15% higher risk of developing cystitis.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding is accompanied by urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria in this disorder.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. In chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females than in males, this disorder causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
In this predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, this syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and low back and unilateral flank pain. In the absence of pyuria, symptoms will usually resolve without intervention.
Urethritis
Primarily found in sexually active males, this infection causes dysuria throughout voiding. It’s accompanied by a reddened meatus and a copious, yellow, purulent discharge (gonorrheal infection) or a white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (In a complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes as well as urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Monoamine oxidase inhibitors and metyrosine can cause dysuria.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Oliguria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute tubular necrosis (ATN)
An early sign of ATN, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias); uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul’s respirations); and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Benign prostatic hyperplasia
This disorder, which is common in men older than age 50, in rare cases may cause oliguria resulting from bladder outlet obstruction. More common symptoms include urinary frequency or hesitancy, urge or overflow incontinence, decrease in the force of the urine stream or inability to stop the stream, nocturia and, possibly, hematuria.
Bladder neoplasm
Uncommonly, this disorder may produce oliguria if the tumor obstructs the bladder outlet. The cardinal signs of such obstruction include urinary frequency and urgency, as well as gross hematuria, which may lead to clot retention and flank pain.
Calculi
Oliguria or anuria may result from stones lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic—excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Cholera
In this bacterial infection, severe water and electrolyte loss lead to oliguria, thirst, weakness, muscle cramps, decreased skin turgor, tachycardia, hypotension, and abrupt watery diarrhea and vomiting. Death may occur in hours without treatment.
Cirrhosis
In severe cirrhosis, hepatorenal syndrome may develop with oliguria, in addition to ascites, edema, fatigue, weakness, jaundice, hypotension, tachycardia, gynecomastia, testicular atrophy, and signs of GI bleeding such as hematemesis.
Glomerulonephritis (acute)
This disorder produces oliguria or anuria. Other features are mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and productive cough).
Heart failure
Oliguria may occur in left ventricular failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, distended jugular veins, tachycardia, tachypnea, crackles, and a dry or productive cough. In advanced heart failure, the patient may also develop orthopnea, cyanosis, clubbing, ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia
Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute)
Accompanying the sudden onset of oliguria in this disorder are high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient also experiences anorexia, nausea, diarrhea, and vomiting.
Renal artery occlusion (bilateral)
This disorder may produce oliguria or, more commonly, anuria. Other features include severe, constant upper abdominal and flank pain, nausea and vomiting, and hypoactive bowel sounds. The patient also develops a fever 1 to 2 days after the occlusion, as well as diastolic hypertension.
Renal failure (chronic)
Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral)
This disorder occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Retroperitoneal fibrosis
Oliguria may result from bilateral ureteral obstruction by dense fibrous tissue. Other effects include hematuria, diffuse low back pain, anorexia, weight loss, nausea and vomiting, fatigue, malaise, low-grade fever, and elevated blood pressure.
Sepsis
Any condition that results in sepsis may produce oliguria, along with fever, chills, restlessness, confusion, diaphoresis, anorexia, vomiting, diarrhea, pallor, hypotension, and tachycardia. The patient may exhibit signs of local infection, such as dysuria and wound drainage. In severe infection, he may develop lactic acidosis marked by Kussmaul’s respirations.
Toxemia of pregnancy
In severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and severe frontal headache. Typically, the oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester, or more than 1 lb (0.5 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture
This disorder produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and diminished urine stream. As obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies
Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs
Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary hesitancy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia
Signs and symptoms of this disorder depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of the urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream, and occasionally urine retention. As the obstruction increases, the patient may develop urinary frequency, nocturia, urinary overflow, incontinence, bladder distention and, possibly, hematuria.
Prostate cancer
In advanced cancer, urinary hesitancy may occur along with frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from urine retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI
Urinary hesitancy may be associated with UTIs. Characteristic urinary changes include frequency, dysuria, nocturia, cloudy urine and, possibly, hematuria. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy also may occur in patients recovering from general anesthesia.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary incontinence:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
Overflow incontinence is common in this disorder as a result of urethral obstruction and urine retention. BPH begins with a group of signs and symptoms known as prostatism: reduced caliber and force of the urine stream, urinary hesitancy, and a feeling of incomplete voiding. As the obstruction increases, the patient may develop urinary frequency, nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder calculus
Overflow incontinence may occur if the calculus lodges in the bladder neck. Associated findings vary but may include those of an irritable bladder: urinary frequency and urgency, dysuria, hematuria, and suprapubic pain from bladder spasms. Pelvic pain may be referred to the tip of the penis, vulva, low back, or heel and may be exacerbated by movement.
Bladder cancer
Urge incontinence and hematuria are common findings in bladder cancer; obstruction by a tumor may produce overflow incontinence. The early stages can be asymptomatic. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy
Autonomic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Guillain-Barré syndrome
Urinary incontinence may occur early in this disorder as a result of peripheral and autonomic nerve dysfunction. The cardinal sign is progressive, profound muscle weakness, which typically starts in the legs and extends to the arms and facial nerves within 24 to 72 hours. Associated findings include paresthesia, dysarthria, nasal speech, dysphagia, orthostatic hypotension, tachycardia, fecal incontinence, diaphoresis, drooling, and pain in the shoulders, thighs, or lumbar region.
Multiple sclerosis (MS)
Urinary incontinence, urgency, and frequency are common urologic findings in MS. Visual problems and sensory impairment are usually the first symptoms. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
Urinary incontinence usually occurs only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic)
Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, a persistent urethral discharge, dull perineal pain that may radiate to other areas, ejaculatory pain, and decreased libido.
Spinal cord injury
Complete cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke
Urinary incontinence may be transient or permanent in a stroke patient. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Sensorimotor effects may include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss. Headache, vomiting, visual deficits, and decreased visual acuity may also occur.
Urethral stricture
Partial obstruction of the lower urinary tract due to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may also occur. As the obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
UTI
Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, a urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery
Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Lower urinary tract infection
❑ Acute pyelonephritis
❑ Urethritis
❑ Vaginitis
❑ Acute prostatitis
❑ Urethral calculus
❑ Reiter syndrome
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Source: Field Guide to Bedside Diagnosis, 2007
Urinary Incontinence:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Cystitis
❑ Benign prostatic hypertrophy
❑ Pelvic floor relaxation
❑ Drugs
❑ Prostatitis
❑ Diabetes
❑ Cough
❑ Multiple sclerosis
❑ Spinal cord compression
❑ Decreased cortical inhibition
❑ Vesicovaginal fistula
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Source: Field Guide to Bedside Diagnosis, 2007
Anuria/Oliguria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Acute tubular necrosis
❑ Prerenal azotemia
❑ Tubular toxins
❑ Bladder outlet obstruction
❑ Bilateral renal artery occlusion
❑ Nephrosclerosis
❑ Acute glomerulonephritis
❑ Interstitial nephritis
❑ Renal artery thrombosis
❑ Renal vein thrombosis
❑ Ureteral calculus with a solitary kidney
❑ Pelvic tumor
❑ Retroperitoneal fibrosis
❑ Infiltrative renal disease
❑ Vasculitis
❑ Rhabdomyolysis
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Source: Field Guide to Bedside Diagnosis, 2007
Urinary tract infection, lower:
Causes
(Handbook of Diseases)
Most lower UTIs result from ascending infection by a single gram-negative enteric bacterium, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, or Serratia. However, in a patient with neurogenic bladder, an indwelling urinary catheter, or a fistula between the intestine and bladder, lower UTI may result from simultaneous infection with multiple pathogens.
Infection may result from a breakdown in local defense mechanisms in the bladder that allow bacteria to invade the bladder mucosa and multiply. These bacteria cannot be readily eliminated by normal micturition.
The risk of cystitis is higher when the bladder or urethra becomes blocked and urine flow stops. It can occur when instruments are inserted into the urinary tract during procedures such as catheterization or cystoscopy. Other risks include pregnancy, diabetes, and a history of analgesic or reflux nephropathy. The elderly are at increased risk for developing UTIs due to incomplete emptying of the bladder; this is associated with conditions such as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility, indwelling urinary catheters, and placement in a nursing home all place the person at risk for developing an infection.
Bacterial flare-up
During treatment, bacterial flare-up is generally caused by the pathogenic organism’s resistance to the prescribed antimicrobial therapy. The presence of even a small number (less than 10,000/ml) of bacteria in a midstream urine sample obtained during treatment casts doubt on the treatment’s effectiveness.
Recurrent UTI
In 99% of patients, recurrent lower UTI results from reinfection by the same organism or from some new pathogen; in the remaining 1%, recurrence reflects persistent infection, usually from renal calculi, chronic bacterial prostatitis, or a structural anomaly that may become a source of infection.
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Source: Handbook of Diseases, 2003
Anuria:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Acute tubular necrosis (ATN)
Oliguria (occasionally anuria) is a common initial finding with ATN. Associated symptoms may reflect the underlying cause, such as hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, convulsions, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral)
Bilateral cortical necrosis is characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute)
Acute glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymosis, edema, hematuria, and pallor. He may also show signs of an upper respiratory tract infection.
Papillary necrosis (acute)
Bilateral papillary necrosis produces anuria or oliguria. It also produces flank pain, costovertebral angle tenderness, renal colic, abdominal pain and rigidity, fever, vomiting, decreased bowel sounds, hematuria, and pyuria.
Renal artery occlusion (bilateral)
Bilateral renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Bilateral renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli — a common complication — produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub, and possibly hemoptysis.
Urinary tract obstruction
Severe obstruction can produce acute, and sometimes, total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis
Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmias, pallor, and possibly skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially aminoglycosides, are the most typically seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bladder distention:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
See Bladder distention: Causes and associated findings, pages 46 and 47.
Benign prostatic hyperplasia (BPH)
With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but more commonly it produces pain as its only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis (MS)
With MS, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, a boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that usually mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Anuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute tubular necrosis
Oliguria (occasionally anuria) is a common finding in acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Glomerulonephritis (acute)
Acute glomerulonephritis produces anuria or oliguria. Related effects include mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome
Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He may also show signs of upper respiratory tract infection.
Renal artery occlusion (bilateral)
Bilateral renal artery occlusion produces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral)
Bilateral renal vein occlusion occasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli — a common complication — produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub and, possibly, hemoptysis.
Urinary tract obstruction
Severe urinary tract obstruction can produce acute and sometimes total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Other causes
Diagnostic tests
Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs
Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bladder distention:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
With benign prostatic hyperplasia (BPH), bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CUE:Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In bladder cancer, a predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
CULTURAL CUE:Bladder cancer is twice as common in White males as in Black males. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding occurs with urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding. Dysuria may be accompanied by a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation.
With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects include urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females, acute pyelonephritis causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
With Reiter’s syndrome, a predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, urethral syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and lower back and unilateral flank pain. In the absence of pyuria, symptoms usually resolve without intervention.
Urethritis
Primarily found in sexually active males, urethritis causes dysuria throughout voiding. It’s accompanied by a reddened meatus and copious, yellow, purulent discharge (gonorrheal infection) or white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features include diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may be caused by contact with irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Dysuria can result from monoamine oxidase inhibitor use. Metyrosine can also cause transient dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Oliguria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute tubular necrosis
An early sign of acute tubular necrosis, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias), uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul’s respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Calculi
Oliguria or anuria may result from calculi lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic — excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Glomerulonephritis (acute)
Acute glomerulonephritis produces oliguria or anuria. Other features are mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and productive cough).
Heart failure
Oliguria may occur in left-sided heart failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, distended jugular veins, tachycardia, tachypnea, crackles, and a dry or productive cough. In advanced heart failure, the patient may also develop orthopnea, cyanosis, clubbing, ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia
Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings in hypovolemia include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute)
Accompanying the sudden onset of oliguria in acute pyelonephritis are high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient with acute pyelonephritis also experiences anorexia, nausea, diarrhea, and vomiting.
Renal artery occlusion (bilateral)
Renal artery occlusion may produce oliguria or, more commonly, anuria. Other features include severe, constant upper abdominal and flank pain, nausea and vomiting, and hypoactive bowel sounds. The patient also develops a fever 1 to 2 days after the occlusion, as well as diastolic hypertension.
Renal failure (chronic)
Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral)
Renal vein occlusion occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Sepsis
Any condition that results in sepsis may produce oliguria, along with fever, chills, restlessness, confusion, diaphoresis, anorexia, vomiting, diarrhea, pallor, hypotension, and tachycardia. The patient may exhibit signs of local infection, such as dysuria and wound drainage. In severe infection, he may develop lactic acidosis marked by Kussmaul’s respirations.
Toxemia of pregnancy
In severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and severe frontal headache. Typically, the oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester or more than 1 lb (0.5 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture
Urethral stricture produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and diminished urine stream. As obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies
Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs
Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary hesitancy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Characteristic early findings of benign prostatic hyperplasia (BPH) include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostate cancer
In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
Urinary tract infection
Urinary hesitancy may be associated UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Urinary hesitancy also may occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary incontinence:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Overflow incontinence is common with benign prostatic hyperplasia (BPH) as a result of urethral obstruction and urine retention. The disorder begins with a group of signs and symptoms known as prostatism: reduced caliber and force of urine stream, urinary hesitancy, and a feeling of incomplete voiding. As obstruction increases, urination becomes more frequent, with nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder calculus
Overflow incontinence may occur if the stone lodges in the bladder neck. Associated findings vary but may include those of an irritable bladder: urinary frequency and urgency, dysuria, hematuria, and suprapubic pain from bladder spasms. Pelvic pain and pain referred to the tip of the penis, vulva, low back, or heel may occur. Pain may be exacerbated by movement.
Bladder cancer
With bladder cancer, the patient commonly presents with urge incontinence and hematuria; obstruction by a tumor may produce overflow incontinence. Symptoms may be absent during the early stages. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy
Diabetic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Guillain-Barré syndrome
Urinary incontinence may occur early in Guillain-Barré syndrome as a result of peripheral and autonomic nerve dysfunction. The most prominent sign is progressive, profound muscle weakness, which typically starts in the legs and extends to the arms and facial nerves within 24 to 72 hours. Associated findings include paresthesia; dysarthria; nasal speech; dysphagia; orthostatic hypotension; fecal incontinence; diaphoresis; drooling; pain in the shoulders, thighs, or lumbar region; and tachycardia.
Multiple sclerosis
Urinary incontinence, urgency, and frequency are common urologic findings in multiple sclerosis. In most patients, vision problems and sensory impairment occur early. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
Urinary incontinence usually appears only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic)
Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, persistent urethral discharge, dull perineal pain that may radiate, ejaculatory pain, and decreased libido.
Spinal cord injury
Complete spinal cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke
Urinary incontinence may be transient or permanent in stroke patients. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Headache, vomiting, visual deficits, and decreased visual acuity are possible. Sensorimotor effects include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss.
Urethral stricture
Eventually, overflow incontinence may occur with urethral stricture. As obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
Urinary tract infection
Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery
Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Principal Causes of Dysuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Urinarytract infection
- Urethritis
- Cystitis
- Pyelonephritis
- Chemical irritation
- Diaper dermatitis
- Trauma
- Psychogenic
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Urinary Incontinence:
Principal Causes of Urinary Incontinence
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Maturationaldelay
- Stress-related causes
- Urinary tract disorders
- Urinarytract infection
- Dysfunctional voiding disorders
- Lower urinary tract obstruction
- Ectopic ureter in girls
- Neurologic disorders
- Mentalretardation
- Neurogenic bladder
- Abdominal or pelvic mass
- Polyuria
- Primary psychologic disturbance
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Anuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute tubular necrosis.Oliguria (occasionally anuria) is a common finding with acute tubular necrosis. It precedes the onset of diuresis, which is heralded by polyuria. Associated findings reflect the underlying cause and may include signs and symptoms of hyperkalemia (muscle weakness, cardiac arrhythmias), uremia (anorexia, nausea, vomiting, confusion, lethargy, twitching, seizures, pruritus, uremic frost, and Kussmaul's respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Cortical necrosis (bilateral).Cortical necrosisis characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain, and fever.
Glomerulonephritis (acute).Acute glomerulonephritisproduces anuria or oliguria. Related effects include a mild fever, malaise, flank pain, gross hematuria, facial and generalized edema, elevated blood pressure, headache, nausea, vomiting, abdominal pain, and signs and symptoms of pulmonary congestion (crackles, dyspnea).
Hemolytic-uremic syndrome.Anuria commonly occurs in the initial stages of hemolytic-uremic syndrome and may last from 1 to 10 days. The patient may experience vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria, and pallor. He also may show signs of upper respiratory tract infection.
Renal artery occlusion (bilateral).Renal artery occlusionproduces anuria or severe oliguria, commonly accompanied by severe, continuous upper abdominal and flank pain; nausea and vomiting; decreased bowel sounds; a fever up to 102° F (38.9° C); and diastolic hypertension.
Renal vein occlusion (bilateral).Renal vein occlusionoccasionally causes anuria; more typical signs and symptoms include acute low back pain, fever, flank tenderness, and hematuria. Development of pulmonary emboli—a common complication—produces sudden dyspnea, pleuritic pain, tachypnea, tachycardia, crackles, pleural friction rub and, possibly, hemoptysis.
Urinary tract obstruction.Severe urinary tract obstruction can produce acute and sometimes total anuria, alternating with or preceded by burning and pain on urination, overflow incontinence or dribbling, increased urinary frequency and nocturia, voiding of small amounts, or an altered urine stream. Associated findings include bladder distention, pain and a sensation of fullness in the lower abdomen and groin, upper abdominal and flank pain, nausea and vomiting, and signs of secondary infection, such as fever, chills, malaise, and cloudy, foul-smelling urine.
Vasculitis.Vasculitis occasionally produces anuria. More typical findings include malaise, myalgia, polyarthralgia, fever, elevated blood pressure, hematuria, proteinuria, arrhythmia, pallor and, possibly, skin lesions, urticaria, and purpura.
Other causes
Diagnostic tests.Contrast media used in radiographic studies can cause nephrotoxicity, producing oliguria and, rarely, anuria.
Drugs.Many classes of drugs can cause anuria or, more commonly, oliguria through their nephrotoxic effects. Antibiotics, especially the aminoglycosides, are the most commonly seen nephrotoxins. Anesthetics, heavy metals, ethyl alcohol, and organic solvents can also be nephrotoxic. Adrenergics and anticholinergics can cause anuria by affecting the nerves and muscles of micturition to produce urine retention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Bladder distention:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi.Bladder calculi may produce bladder distention, but more commonly pain is the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer.By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis.With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
Prostate cancer.Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis.With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare; however, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms.Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi.With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture.Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization.Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs.Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Appendicitis.Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney's point, anorexia, nausea, vomiting, constipation, a slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer.Bladder cancer, a predominantly male disorder, causes dysuria throughout voiding—a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cystitis.Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and a fever.
Paraurethral gland inflammation.Dysuria throughout voiding occurs with urinary frequency and urgency, a diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis.Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, a fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; a diminished urine stream; perineal, back, and buttock pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute).Pyelonephritis causes dysuria throughout voiding. Other features include a persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter's syndrome.Reiter's syndrome is a disorder in which dysuria occurs 1 or 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and a low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urinary obstruction.Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are a diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis.Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia with vaginitis. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants.Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it's usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs.Dysuria can result from monoamine oxidase inhibitors. Metyrosine can also cause transient dysuria.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Oliguria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute tubular necrosis (ATN).An early sign of ATN, oliguria may occur abruptly (in shock) or gradually (in nephrotoxicity). Usually, it persists for about 2 weeks, followed by polyuria. Related features include signs of hyperkalemia (muscle weakness and cardiac arrhythmias), uremia (anorexia, confusion, lethargy, twitching, seizures, pruritus, and Kussmaul's respirations), and heart failure (edema, jugular vein distention, crackles, and dyspnea).
Calculi.Oliguria or anuria may result from calculi lodging in the kidneys, ureters, bladder outlet, or urethra. Associated signs and symptoms include urinary frequency and urgency, dysuria, and hematuria or pyuria. Usually, the patient experiences renal colic—excruciating pain that radiates from the CVA to the flank, the suprapubic region, and the external genitalia. This pain may be accompanied by nausea, vomiting, hypoactive bowel sounds, abdominal distention and, occasionally, fever and chills.
Cholera. With cholera, severe water and electrolyte loss lead to oliguria, thirst, weakness, muscle cramps, decreased skin turgor, tachycardia, hypotension, and abrupt watery diarrhea and vomiting. Death may occur in hours without treatment.
Glomerulonephritis (acute).Acute glomerulonephritis produces oliguria or anuria. Other features are a mild fever, fatigue, gross hematuria, proteinuria, generalized edema, elevated blood pressure, headache, nausea and vomiting, flank and abdominal pain, and signs of pulmonary congestion (dyspnea and a productive cough).
Heart failure.Oliguria may occur with left-sided heart failure as a result of low cardiac output and decreased renal perfusion. Accompanying signs and symptoms include dyspnea, fatigue, weakness, peripheral edema, jugular vein distention, tachycardia, tachypnea, crackles, and a dry or productive cough. With advanced or chronic heart failure, the patient may also develop orthopnea, cyanosis, clubbing, a ventricular gallop, diastolic hypertension, cardiomegaly, and hemoptysis.
Hypovolemia. Any disorder that decreases circulating fluid volume can produce oliguria. Associated findings include orthostatic hypotension, apathy, lethargy, fatigue, gross muscle weakness, anorexia, nausea, profound thirst, dizziness, sunken eyeballs, poor skin turgor, and dry mucous membranes.
Pyelonephritis (acute).Accompanying the sudden onset of oliguria with acute pyelonephritis are a high fever with chills, fatigue, flank pain, CVA tenderness, weakness, nocturia, dysuria, hematuria, urinary frequency and urgency, and tenesmus. The urine may appear cloudy. Occasionally, the patient also experiences anorexia, diarrhea, and nausea and vomiting.
Renal failure (chronic).Oliguria is a major sign of end-stage chronic renal failure. Associated findings reflect progressive uremia and include fatigue, weakness, irritability, uremic fetor, ecchymoses and petechiae, peripheral edema, elevated blood pressure, confusion, emotional lability, drowsiness, coarse muscle twitching, muscle cramps, peripheral neuropathies, anorexia, a metallic taste in the mouth, nausea and vomiting, constipation or diarrhea, stomatitis, pruritus, pallor, and yellow- or bronze-tinged skin. Eventually, seizures, coma, and uremic frost may develop.
Renal vein occlusion (bilateral).Bilateral renal vein occlusion occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged and palpable kidneys, edema and, possibly, signs of uremia.
Toxemia of pregnancy.With severe preeclampsia, oliguria may be accompanied by elevated blood pressure, dizziness, diplopia, blurred vision, epigastric pain, nausea and vomiting, irritability, and a severe frontal headache. Typically, oliguria is preceded by generalized edema and sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester, or more than 1 lb (0.45 kg) per week during the third trimester. If preeclampsia progresses to eclampsia, the patient develops seizures and may slip into coma.
Urethral stricture.Urethral stricture produces oliguria accompanied by chronic urethral discharge, urinary frequency and urgency, dysuria, pyuria, and a diminished urine stream. As the obstruction worsens, urine extravasation may lead to formation of urinomas and urosepsis.
Other causes
Diagnostic studies.Radiographic studies that use contrast media may cause nephrotoxicity and oliguria.
Drugs.Oliguria may result from drugs that cause decreased renal perfusion (diuretics), nephrotoxicity (most notably, aminoglycosides and chemotherapeutic drugs), urine retention (adrenergics and anticholinergics), or urinary obstruction associated with precipitation of urinary crystals (sulfonamides and acyclovir).
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary hesitancy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).Signs and symptoms of BPH depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostatic cancer.In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion.A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture.Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI.Urinary hesitancy may be associated with a UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs.Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy may also occur in those recovering from general anesthesia.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary incontinence:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).Overflow incontinence is common with BPH as a result of urethral obstruction and urine retention. BPH begins with a group of signs and symptoms known as prostatism: reduced caliber and force of urine stream, urinary hesitancy, and a feeling of incomplete voiding. As obstruction increases, urination becomes more frequent, with nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder cancer.With bladder cancer, the patient commonly presents with urge incontinence and hematuria; obstruction by a tumor may produce overflow incontinence. The early stages may not produce symptoms. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy.Autonomic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Multiple sclerosis (MS).Urinary incontinence, urgency, and frequency are common urologic findings in MS. In most patients, vision problems and sensory impairment occur early. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer.Urinary incontinence usually appears only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic).Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, persistent urethral discharge, dull perineal pain that may radiate, ejaculatory pain, and decreased libido.
Spinal cord injury.Complete cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke.With a stroke, urinary incontinence may be transient or permanent. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Headache, vomiting, visual deficits, and decreased visual acuity are possible. Sensorimotor effects include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss.
Urethral stricture.Eventually, overflow incontinence may occur with a urethral stricture. As obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
UTI.Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery.Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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