AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Just returned from hospital. What could cause my 15-year-old daughter to not have a feeling to urinate? She did not urinate for at least 2 days. When she tried, nothing would happen. When catherized they got 1200 ccs. Will be going back in a week unless she cannot urinate again within 16-18 hours, then she'll go back sooner. Thought to be neurological because of other health issues. Now they're saying it's because of medicine for hemiplegic migraines, but this was happening before the amitriphtilyne also. Please help us. We have a lot of puzzle pieces to her health but nobody to put all the pieces together. (By the way, she keeps on having kidney stones too.) Thanks for your help. God bless you.
Answer Lisa, as you might imagine, for this type of problem it is not possible for me to make an exact diagnosis over the internet because of the inability to take a complete history & do a physical examination. However, I shall try to help you.
There are many conditions that may cause difficulty emptying the bladder. Ones ability to urinate depends on 2 opposing factors: the force with which the bladder muscle contracts which has to work against the resistance in the urinary canal (urethra). Anything which decreases the former or increases the latter make it more difficult to urinate and empty the bladder efficiently. Normally, after urination the bladder should retain less than 30 cc (one ounce) of urine. This is called the "residual urine". Excessive “residual urine” can predispose to urinary infections and kidney damage from back pressure. In addition, chronic distention of the bladder muscle prevents it from contracting with maximum force which exacerbates the residual urine accumulation. In women, poor vaginal support of the bladder &/or uterus can cause a cystocele (sagging bladder) or uterine prolapse (procidentia) which can both interfere with normal bladder evacuation. This would be unlikely in an 15 year old. Bladder contractile force can also be adversely affected by a number of medications including those used for anxiety, depression, pain (especially narcotics), antihistamines, GI disorders, & many other conditions. This may well be a factor in your daughter's case. Furthermore, putting off the desire to void by holding the urine too long, over-stretches the bladder muscle which interferes with it's ability to contract forcefully enough to empty. Urinary retention can also be precipitated by excessive alcohol as this is a central nervous system depressant (again unlikely). Alcohol may also prevent one from being aware that their bladder is full before it is too late. Certain neurologic diseases, such as herniated discs, MS, parkinsonism, etc. often adversely affect bladder emptying. Lyme disease sometimes affects the central nervous system and occasionally causes urinary retention.
Disorders that may increase the resistance in the urethra include urethral stricture (narrowing), cystoscele, uterine prolapse, urethral stenosis, etc. Estrogen deficiency may be a factor in some cases.
As there are so many disorders that can cause you voiding difficulty, your daughter needs to see a urologist in consultation . A complete history, physical examination and some laboratory tests are needed. At the very least, measurement of the residual urine will be done. Depending on the above, further testing such as a cystoscopy, urodynamic studies, and imaging of the upper urinary tract may be indicated. Do not wait any longer to get checked out! Although this might sound complicated, usually the problem can be managed quite successfully by relatively simple means. The key to treatment, however, is find the cause of the retention.
The formation of kidney stones is a very complex process & may or may not be related to the present problem. Obvious predisposing factors such as anatomical obstruction to the flow of urine from the kidneys and urinary tract infections need to be ruled out. In addition, there are many different types of stones (such as calcium oxalate, calcium phosphate, uric acid, calcium ammonium phosphate, cystine, etc.). Furthermore, each type of stone has many potential causes and multiple metabolic factors are involved. Calcium oxalate is the most common stone formed in this country. In recurrent stone formers, therefore, a complete metabolic evaluation is necessary before a proper stone prevention program can be instituted. If one has had 2 or more stones, you would fall into this category. Some stones can be stabilized or prevented by dietary regimens but none are really dissolved by them. Forcing fluids to ensure a urinary output of at least 2,000 cc (2 liters) daily is an essential part of all stone prevention and treatment programs. There is an incorrect belief that by reducing dietary calcium (by eliminating dairy products) in patients with any type of calcium stone prevents calculi. This may help help with some types of stones but may predispose to others. Therefore, metabolic evaluation is recommended in patients with recurrent urinary stones before preventive therapy can be suggested. Metabolic studies are a series of tests to try and determine why a person forms stones. They usually include routine blood chemistries, a serum parathyroid hormone (PTH) level, and a 24 hour urinary assay for those constituents in the urine involved in stone formation. Other specialized studies that measure calcium absorption from the bowel and acid excretion by the kidneys are occasionally necessary as well. If the metabolic cause of the stone is found, a proper diet and medications can prevent recurrences in about 90% of patients. However, it is essential to do the above tests first as a treatment for one type of stone may cause stones of a different variety to grow. I would suggest that these studies be arranged either by a urologist, a nephrologist or a metabolic disease specialist. Good luck.
