Renal Q from .......... :) :) - torukmakto

[ArchivalUser]

A 62-year-old man presents to the emergency department with severe back pain that began suddenly after he attempted to lift a heavy box. He says the pain radiates down his right thigh and leg and that coughing and moving make the pain ‘unbearable.’ The patient also complains of an inability to urinate since the pain started. On physical examination, he has no focal lower extremity weakness or numbness, and pinprick testing in the perianal area elicits a quick spasm of the anal sphincter. Rectal exam reveals an enlarged, smooth, nontender prostate. Which of the following best explains this patients urinary retention?

A. Severe pain
B. Nerve root injury
C. Detrusor instability
D. Hypertonic bladder
E. Urethral injury

Please explain your answer
Thank you.

[ArchivalUser]

D? pt has bph

[ArchivalUser]

A

bph ---> patient strains ---> disc impinges on cord ---> pain ---> stops urinating

[ArchivalUser]

uw question..correct answer is A

This patient appears to have herniated an intervertebral disk, most likely L4/L5, and is most likely suffering from spinal nerve impingement. Classic symptoms of disk prolapse include unilateral radicular pain in a dermatome! distribution. Back tenderness due to spasm of the paraspinous muscles is common, and symptoms are usually worsened with straight leg raise testing. Fortunately, this patient has no saddle anesthesia and his sphincter tone is intact, so cauda equina syndrome is an unlikely explanation for his urinary retention. He does have benign prostatic hypertrophy (BPH) on physical examination, meaning that he likely needs to Valsalva in order to initiate and maintain a urinary stream. Because he has severe pain with coughing and movement, he is probably unable to generate sufficient intraabdominal pressure to overcome the resistance to flow caused by his BPH - hence urinary retention secondaryto pain.

(Choice B) A large midline disk herniation can cause nerve root injury known as cauda equina syndrome, a condition characterized by bladder atony with overflow incontinence, bilateral sciatica, saddle anesthesia and loss of anal sphincter tone.

(Choice C) Detrusor instability, also known as urge incontinence, typically presents with incontinence preceded by sudden urinary urgency. It is caused by unregulated spontaneous contractions of the bladder that are unresponsive to cortical inhibition.

(Choice D) Hypertonic bladder presents with constant urine dribbling due to unremitting contraction of the bladder and urethral sphincter hypotonia.

(Choice E) Urethral injury typically occurs following trauma. Patients present with blood at the urethral meatus and perineal ecchymosjs and hematoma.

Educational objective:
Severe pain in a patient with a mild urinary obstruction, such as BPH. may cause urinary retention due to inability to Valsalva

[ArchivalUser]

Hi mlenailer Thank you so much for your detailed explanation. You are right

[ArchivalUser]

nice Q .thanks