While these conditions are unrelated and
have different symptoms, they all require urgent care.
Delaying treatment in some cases can result in surgical
removal of testicles (orchiectomy), permanent inability to
achieve an erection (impotence), or death.
Acute Urinary Retention
Acute urinary retention is the sudden inability to urinate and
is usually symptomatic of another condition that needs
treatment.
Incidence and Prevalence
Anyone can experience acute urinary retention. The causes and
rate of occurrence varies greatly between genders until about
age 60, when men are more often affected as a result of benign
prostatic hyperplasia (BPH).
Risk Factors
Kidney stones, prostate cancer, prostatitis, and BPH are risk
factors in men. Women with a history of kidney stones or
urinary tract infections (UTIs), pregnant women, and those who
have had recent gynecological surgery are at higher risk.
Causes
Acute urinary retention is caused by obstruction in the
bladder or the tube that carries urine from the bladder
outside the body (urethra), a disruption of sensory
information in the nervous system (e.g., spinal cord or nerve
damage), or a situation or event that causes the bladder to
become distended.
Factors associated with acute urinary retention include the
following:
Alcohol consumption
Allergy or
cold medications containing decongestants or
antihistamines
Certain
prescription drugs (e.g., ipratropium bromide, albuterol,
epinephrine) that cause the urethra to become narrow
Delaying
urination for a long time
Long period
of inactivity or bed rest
Prolonged
exposure to cold temperatures
Spinal cord
injury/nerve damage
Surgery
(e.g., complication of anesthesia)
Urinary
system obstruction (e.g., benign prostatic hyperplasia (BPH),
kidney stones)
urinary tract
infection
Signs and Symptoms
Acute urinary retention produces severe lower abdominal pain,
a distended abdomen, and/or the sudden inability to pass
urine.
Complications that may develop with untreated urinary
retention include bladder damage and chronic kidney failure.
Diagnosis
Diagnosis is based on a sudden lack of urinary output and
bladder swelling (distention) observed during a physical
examination.
Treatment
Treatment should be obtained within 5 hours of the onset of
symptoms to avoid the development of complications. The
underlying cause of urinary retention (e.g., kidney stones)
must be diagnosed and treated as well.
A small tube (catheter) is inserted into the bladder through
the urethra to drain the urine. Catheterization relieves pain
and distention.
Prognosis
Depending on the underlying cause, the recurrence rate can be
up to 70% within a week after initial treatment. BPH is
responsible for most recurrences.
Fournier’s Gangrene
Fournier’s gangrene, sometimes called Fournier’s disease, is a
bacterial infection of the skin that affects the genitals and
perineum (i.e., area between the scrotum and anus in men and
in women between the vulva and anus). The disease develops
after a wound or abrasion becomes infected. A combination of
anaerobic (living without oxygen) microorganisms (e.g.,
staphylococcal) and fungi (e.g., yeast) causes an infection
that spreads quickly and causes destruction (necrosis) of
skin, tissue under the skin (subcutaneous tissue), and muscle.
Staphylococcal bacteria clot the blood, depriving surrounding
tissue of oxygen. The anaerobic bacteria thrive in this
oxygen-depleted environment and produce molecules that
instigate chemical reactions (enzymes) that further the spread
of the infection. Fournier’s gangrene can be fatal if the
infection enters the bloodstream.
Incidence and Prevalence
Men are ten times more likely than women to develop Fournier’s
gangrene. Men aged 60-80 with a predisposing condition are
most susceptible.
Women who have had a pus-producing bacterial infection
(abscess) in the vaginal area, a surgical incision in the
vagina and perineum to prevent tearing of skin during delivery
of a child (episiotomy), an abortion resulting in fever and an
infection of the lining of the uterus (septic abortion), or
surgical removal of the uterus (hysterectomy) are susceptible.
Rarely, children may develop Fournier’s gangrene as a
complication in wounds that result from a burn, circumcision,
or insect bite.
Risk Factors
Men with alcoholism, diabetes mellitus, leukemia, morbid
obesity, and immune system disorders (e.g., HIV, Crohn’s
disease), and intravenous drug users are at increased risk for
developing Fournier’s gangrene. Surgery is also a risk factor.
Causes
Fournier’s gangrene develops when multiple bacteria infect the
body through a wound, usually in the perineum, tube that
carries urine outside the body from the bladder (urethra), or
colorectal area. Existing immune system deficiencies help
infection to spread quickly, producing a disease that destroys
the skin and superficial and deep fascia (membranes that
separate muscles and protect nerves and vessels) of the
genital area. The chambers in the penis that fill with blood
to create an erection (corpora cavernosa), testicles, and
urethra are not usually affected.
Signs and Symptoms
The early physical symptoms of Fournier’s gangrene do not
always indicate the severity of the condition. Pain sometimes
diminishes as the disease progresses. Symptoms are progressive
and include the following:
Crepitant
("spongy" to the touch) skin
Dead and
discolored (gray-black) tissue; pus weeping from injury
Fever and
drowsiness (lethargy)
Increasing
genital pain and redness (erythema)
Odor
Severe
genital pain accompanied by tenderness and swelling of the
penis and scrotum
Diagnosis
Physical examination and blood tests are necessary. A
diagnosis is made on finding gangrenous (i.e., spongy,
weeping, discolored) skin. Microscopic examination of a tissue
specimen (biopsy) may be taken if visible symptoms are
insufficient to distinguish between Fournier’s and other
bacterial infections.
Treatment
Antibiotics (often double or triple drug therapy) along with
aggressive surgical removal of all of the diseased tissue is
required immediately for an optimal outcome.
Without early treatment, bacterial infection enters the
bloodstream and can cause delirium, heart attack, respiratory
failure, and death.
Complications
Incomplete debridement (surgical removal of dead tissue)
allows wound infection to continue to spread. In this event,
follow-up surgery is performed.
For more information about The Austin Diagnostic Clinic's
urology department or this topic,
please call 512/901-4021.
The Austin Diagnostic Clinic, A
Multi-Specialty Medical Clinic
12221 MoPac Expressway North |
Austin, TX 78758 | 512.901.1111
Serving the communities of Austin, Round Rock, Pflugerville, San
Marcos and
Central Texas since 1952
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