In this section : Renal
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Acute Kidney Injury (AKI)
Urinary Tract Infection
Urethral Catheterisation
Kidney Transplantation
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Management of Urinary Symptoms
Last updated 30th March 2022
Clinical Scenarios
- Obstructive symptoms – hesitancy, poor flow, difficulty emptying and dribbling
- Irritative symptoms – urgency, frequency, nocturia
- Urinary retention – can be acute or chronic
- Incontinence – stress, urge and overflow
- Dysuria – usually a sign of infection – Click to view section on Urinary Tract Infection
- Haematuria – may be visible or invisible with significant risk of urological malignancy in men and women >40 years
- If a patient presents with urinary symptoms you should take a history and dip the urine to exclude infection, haematuria or sterile pyuria which may require further investigation.
Management of Obstructive Urinary Symptoms
- Symptoms are more common in men than women. Poor flow etc can result from obstruction (eg BPH, stricture etc) or poor bladder muscle tone (hypotonic bladder)
- Most male patients with obstructive symptoms are treated initially for BPH. There are two groups of drugs used in this scenario.
- Alpha-blockers eg Tamsulosin 400microgrammes/day relax the smooth muscle at bladder neck and prostatic urethra. They tend to act quickly. Side effects include dizziness due to postural hypotension.
- 5 alpha-reductase inhibitors such as Finasteride 5mg/day. These inhibit production of dihydrotestosterone to reduce the size of the prostate. They act over a period of months. They are generally well tolerated but can cause ED in 5% of men. In practise both drugs are often used in combination.
Management of Irritative Urinary Symptoms
- These symptoms are common in both men and women.
- Exclude infection. Advise minimal caffeine intake. Avoid fluid late at night
- If fails to improve anticholinergic therapy eg Trospium XL 60mg od is often used as the underlying cause is often an overactive bladder. Topical oestrogens are often helpful in postmenopausal women.
Retention of Urine (>400ml)
- Initial management includes rectal examination to document prostate size and exclude prostate cancer, catheterisation, documentation of residual volume of urine drained and assessment of renal function.
- If the patient has a high pressure retention (ie deranged U+E), renal function should be monitored closely to ensure that it improves following catheterisation. A renal US should also be arranged to exclude hydronephrosis. These patients should be left catheterised and referred to urology.
- Patients with low pressure retention (ie normal U+E) should be given an alpha-blocker eg Tamsulosin 400microgrammes/day and given a trial without catheter after 7 days. If successful, the patient should be referred to urology for out patient review.
Content updated by Ian Russell