22- Urinary Problems

Urinary retention

Urinary retention (sux002) does NOT mean that patients do not pass urine, but rather means that they cannot empty the bladder!  Patients typically complain of: pain and difficulty with urination; "symmetrical tumor" in lower abdomen (+dullness on percussion); frequent urination but only a few drops each time (hold the diaper open in a way you can observe the urethral meatus and softly press with your hand palm on the lower abdomen.  You will often observe a few drops of urine coming out); or, rarely, no urine is passed at all.

1- Often, the cause of urinary retention in an AIDS hospice is brain damage.  This could be either reversible viral disease or severe irreversible brain damage...  We should consider first Toxoplasmosis, Cryptococcosis, Cerebral TB, HIV Dementia...  (Perform a neuro examination and see "19-Neuro" protocol).

2- For males, think about prostate infection (poor or no treatment after former pyuria/venereal disease?)  Patients can often tell you about past problems, and the prostate is painful/enlarged on palpation.  Consider chlamydia, gonorrhea or other venereal diseases.  Try doxycycline 100mg 2x/day for 10 days if you have no better ideas after reading the "15-Genital" protocol.

3- If we cannot find the cause, we use a catheter for a few days.  If problems persist, a new long-term catheter may be required.  It is best to insert a new catheter after 4 days of antibiotic coverage (ciprofloxacin 500mg 2x/day) starting one day before placement of catheter and continuing for 3 days after.

Pollakiuria(Polyuria)

(Nothing specific for HIV patients)

- Give a lot of water -- the best drug!

- Short antibiotic cure: norfloxacin 400mg 2tabs/day for 3 days

- If not better and/or if pyurrhea and/or prostatic problems (retention, pain/edema of prostate) consider also chlamydia, gonorrhea or other venereal diseases.  Try doxycycline 100mg 2tabs/day for 10 days if you have no better ideas after reading the "15-Genital" protocol.

Red urine

(Nothing specific for HIV patients)

- Suspect hemorrhagic problem first.  Petechia?  (pxx021)  (pxxo55)  Epistaxis?  Melena?  (scx008)... If the answer is yes, see "16-Hemorrhage" protocol.

- Consider mechanical problems, including catheters and urinary calculi.

- Common cause is rifampicin!!! (sux021)  This is not harmful, so continue to treat TB!

-Vitamins and some "chemical colored toffees" can also give colored urine.

Dark urine

(Nothing specific for HIV patients)

- Suspect dehydration first.  See "8-Dehydration".

- If patient is icteric and stools are very pale/white, think about hepatic failure (hepatitis...).

- Suspect hemorrhagic problem as well (see red urine)

- Vitamins and some "chemical colored toffees" can also give colored urine.

Pyuria/venereal disease

Consider chlamydia, gonorrhea or other venereal diseases.  Try doxycycline 100mg 2tabs/day for 10 days if you have no better ideas after reading "15-Genital" protocol.