Approach To A Child Presenting With Urinary Retention

Acute urinary retention is relatively infrequent in children. There are a variety of causes that are poorly defined in the literature, and they differ greatly from those seen most frequently in adults.

Urinary retention means an inability to void or unable to empty the bladder.

Taking the History
When a child presents with the complains of inability to void a detailed history is required in order to reach the diagnosis and then manage accordingly.

Ask:

1. If the patient is toilet trained?

2. Is patient constipated

3. Is there pain on urination or fever

4. Any history of trauma

5. Past history of UTI

6. Any history suggestive of sexual abuse

7. Any medications currently in use

Physical Examination
After a detailed history relevant physical examination is necessary that may include

• General Physical Appearance: the child may appear ill looking and uncomfortable.
• Abdomen: Tender , tense smooth suprapubic mass usually indicates a distended urinary bladder.
• Genitalia: Phimosis ( if uncircumcised) , meatal stenosis and erythema of perpuse or glans may represent acute balanoposthitis or erythema may indicate sexual abuse.
• Neurological examination: is needed to assess the sensation in the perineal area.

Investigations
Obtain Basic metabolic panel, CBC with differentials, urine for analysis and culture. Other tests that may be required are:

• KUB
• Renal and Bladder ultrasound
• Voiding Cystourethrogram
• Urodynamic studies: may be required if neurological or functional cause is suspected.
• MRI scan of abdomen and Lumbosacral spine.

Differential Diagnosis

• Transitional Voiding or Dysfunctional Voiding Syndromes: intermediate stage of toilet training, fright of bathrooms
• Constipation: Large amounts of stool in the colon can impinge on the bladder
• UTI: Child with UTI can present with either urinary frequency or retention.
• Bladder outlet obstruction: due to posterior urethral valves in male children.
• Neurogenic bladder
• Pelvic malignancy : rare cause
• Sexual abuse or any other Psychological stressor.

Treatment
It is important to determine if the patient needs any medical intervention( like catheterization) or simply assistance with elimination. If the patient has signs and symptoms of UTI , a neurogenic disorder , or abnormalities on ultrasound, intervention is more to be necessary.

Consultation with a urologist may be needed when posterior urethral valves are demonstrated.

In cases of organic urinary retention where catheterization is necessary try a10 or 12 Fr Foley’s catheter . leave the catheter in place and consult a urologist if needed.