Causes of retention of urine
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Here is a complete, classified account of the causes of retention of urine:
Causes of Retention of Urine
Retention of urine = accumulation of urine in the bladder with inability to void, while the kidneys continue to excrete urine normally (unlike anuria, where the bladder is empty).
Types
| Type | Features |
|---|---|
| Acute | Sudden, painful inability to void; bladder palpable, tense, dull |
| Chronic | Gradual, painless accumulation; patient may be unaware; may present with overflow incontinence or frequency |
| Acute-on-chronic | Chronic retention with sudden painful exacerbation, often triggered by infection |
A. Mechanical Causes
Within the bladder
- Stone in the bladder
- Tumour / blood clot (clot retention)
- Contracture of the bladder neck
Prostate
- Benign prostatic hyperplasia (BPH) - the commonest cause in males (193/300 cases in a large series)
- Carcinoma of the prostate
- Prostatic abscess
Urethra
- Urethral stricture
- Rupture of the urethra
- Congenital posterior urethral valves (important in infants/children)
- Acute urethritis
- Impacted urethral calculus (stone)
- Urethral growth / papilloma
- Foreign body in the urethra
- Pin-hole meatus / meatal ulcer / meatal stenosis
Prepuce
- Phimosis
- Paraphimosis
Compression from outside (extrinsic causes)
- Retroverted gravid uterus (pregnancy)
- Fibroid uterus
- Ovarian cyst
- Carcinoma of the cervix uteri
- Carcinoma of the rectum
- Any pelvic mass / growth
B. Neurogenic Causes
Spinal cord disease
- Disseminated sclerosis (multiple sclerosis)
- Tabes dorsalis
- Transverse myelitis
Injuries and diseases of the spine
- Fracture-dislocation of the spine
- Pott's disease (spinal tuberculosis)
Miscellaneous neurogenic / reflex causes
- Postoperative retention (very common - reflex inhibition after pelvic/perineal surgery or general anaesthesia)
- Hysteria (psychogenic retention)
- Tetanus
- Drugs (see below)
C. Pharmacological Causes
Drugs that impair detrusor contractility or increase urethral tone:
- Anticholinergics (oxybutynin, atropine, tricyclic antidepressants)
- Smooth muscle relaxants
- Tranquillisers / sedatives
- Sympathomimetics (alpha-agonists increase urethral sphincter tone)
- Alcohol (CNS depression, diuresis)
- Opioids (inhibit detrusor)
- Antihistamines
D. Special Situations
- Infants and children: neurological origin or posterior urethral valves are the most likely causes
- Unconscious/shocked patients: retention is easily missed; routine examination required
- Constipation: faecal loading can compress the urethra/bladder neck (listed among miscellaneous causes)
Summary Table from Pye's Surgical Handicraft (300 consecutive cases)
| Cause | Cases |
|---|---|
| Benign prostatic hyperplasia | 193 |
| Malignant disease of prostate | 39 |
| Urethral stricture | 23 |
| Phimosis | 14 |
| Vesical tumour (clot retention) | 9 |
| Inflammation (cystitis/prostatitis) | 4 |
| Spinal injury | 4 |
| Neurological disease | 4 |
| Impacted urethral calculus | 3 |
| Rupture of urethra | 2 |
| Papilloma of urethra | 1 |
| Miscellaneous (drugs, constipation) | 4 |
Key clinical point: The prostate is the commonest cause of retention in males. In females and in children, neurological causes and pelvic masses should be considered first. Drug history (especially anticholinergics, opioids, sympathomimetics) is a frequently missed but reversible cause.
Sources: S. Das - A Manual on Clinical Surgery, 13th Ed., p. 595-596; Pye's Surgical Handicraft, 22nd Ed., p. 326
Homeopathic therapeutic of urinary tract infections
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homeopathic remedies urinary tract infection Cantharis Apis Staphysagria materia medica
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https://www.peacehealth.org/medical-topics/id/hn-2262002
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homeopathy "urinary tract infection" treatment
Here is a detailed guide to homeopathic therapeutics for urinary tract infections (UTIs), based on classical materia medica and current homeopathic prescribing references:
Homeopathic Therapeutics of Urinary Tract Infections
Important note: The medical textbook library does not contain homeopathic texts. The information below is drawn from established homeopathic materia medica, clinical prescribing references (including PeaceHealth Health Library), and published case literature. Homeopathic prescribing is highly individualised - the remedy is matched to the total symptom picture of the patient, not just the diagnosis. Patients with fever, kidney pain, or severe symptoms should seek conventional medical evaluation, as ascending UTIs (pyelonephritis) require antibiotic therapy.
Homeopathic Approach to UTI
Homeopathy treats the individual, not the disease. Remedy selection depends on:
- The character of pain (burning, stinging, cutting, aching)
- When the pain is worst (before, during, or after urination)
- Urine appearance (cloudy, blood-tinged, scanty, odorous)
- Modalities (what makes it better or worse - heat, cold, motion, position)
- General and mental symptoms accompanying the UTI
Primary Remedies
1. Cantharis (Spanish Fly - Lytta vesicatoria)
The most frequently indicated remedy for acute cystitis.
- Intense burning and cutting pain before, during, and after urination
- Violent, constant urge to urinate with only drops passed each time
- Scalding sensation; urine passed drop by drop
- Feeling of bladder never being fully emptied
- Haematuria (blood in urine) is common
- May have concomitant sexual arousal (a keynote)
- Essentially an acute/psoric remedy
Potency: 30C is commonly used; 200C in intense cases.
2. Apis Mellifica (Honey Bee)
- Frequent urge with only small quantities passed
- Stinging and burning, especially with the last few drops
- Soreness in the lower abdomen
- No thirst (an important keynote)
- Heat and touch aggravate; cold applications and open air relieve
- Useful where there is oedema or swelling
3. Staphysagria (Stavesacre)
- Classic remedy for "honeymoon cystitis" - UTI triggered by sexual intercourse (especially in young women or after new sexual activity)
- UTI following catheterisation or prolonged bed rest
- Sensation of a drop rolling down the urethra after urination
- Feeling of bladder still full even after voiding
- Constant burning sensation
- Useful when there is suppressed anger or emotional upset as a trigger
- Belongs to the sycotic miasm
4. Nux Vomica (Poison Nut)
- Irritable bladder with constant, ineffectual urge to urinate
- Passes only small amounts; burning or cramping in bladder area
- Itching sensation in the urethra during urination
- Patient is very irritable, impatient, and chilly
- Symptoms relieved by heat (hot baths)
- Often indicated in patients who overuse stimulants (coffee, alcohol, spices)
5. Sarsaparilla (Wild Sarsaparilla)
- Severe pain at the end of urination (closing pain) - a keynote
- Can urinate better standing; sitting is difficult
- Urine may be clear but passed with difficulty
- Right-sided renal extension of infection; associated with urinary lithiasis
- Syphilitic miasm component
6. Berberis Vulgaris (Barberry)
- Shooting, radiating pain from the bladder/kidney extending to the thighs or back
- Burning sensation even when not urinating
- After urinating, feels as if urine remains inside
- Urging and discomfort are worse from walking
- Cutting pain at the urethral opening
- Well indicated in UTIs with associated renal colic or kidney stones
7. Belladonna (Deadly Nightshade)
- Frequent, intense urge to urinate
- Highly-coloured urine passed in small amounts
- Bladder feels very sensitive; cramping sensation
- May pass small amounts of blood (without serious pathology)
- Sudden onset; symptoms are hot, red, throbbing in character
Other Useful Remedies
| Remedy | Key Indication |
|---|---|
| Aconitum napellus | Sudden onset after exposure to cold; anxiety before and during urination; hot, scanty urine; retention from chill or shock |
| Clematis | Constriction in urethra; interrupted flow; dribbling after urination; tingling lasting long after |
| Equisetum (Horsetail) | Dull, distressing pain with fullness even after voiding; urging worse when bladder is empty |
| Lycopodium | Right-sided affinity; red sediment in urine; craving sweets; 4-8 PM aggravation |
| Borax | UTI with anxiety; downward motion aggravates; useful in children |
| Pulsatilla | Bland, changeable symptoms; worse lying down; patient is yielding, weepy, craves open air; no thirst |
| Sepia | Chronic/recurrent UTIs in women; bearing-down sensation; indifferent; worse before menses |
Biotherapeutic (Nosode) Medicines
Used particularly in recurrent UTIs (RUTIs):
- Colibacillinum (E. coli nosode): Used in low potency (D4-D8) as an adjunct in confirmed colibacillary infections; in high potency (9C-30C) it improves the general condition
- Anti-colibacillary serum: Used almost systematically by many homeopathic physicians in any UTI, regardless of bacterial type or site of infection
- Medorrhinum (gonorrhoeal nosode): For chronic recurrent cystitis with sycotic background
- Tuberculinum: Indicated when chronic colibacillosis is linked to the tuberculin reaction mode (chronic constitutional treatment)
Remedy for Special Situations
| Situation | Remedy to Consider |
|---|---|
| Post-coital cystitis | Staphysagria |
| After catheterisation | Staphysagria |
| After cold/chill | Aconitum |
| With renal colic/stones | Berberis vulgaris, Sarsaparilla |
| Haematuria prominent | Cantharis, Terebenthina |
| Ascending UTI / kidney involvement | Terebenthina (urine smells of violets - keynote), Berberis |
| Recurrent UTIs (constitutional) | Sepia, Medorrhinum, Colibacillinum |
| UTI in irritable/stressed individual | Nux vomica, Staphysagria |
Terebenthina (Turpentine)
A less common but important remedy:
- UTI with haematuria and kidney pain
- Albuminuria
- Urine has a characteristic odour of violets - a keynote
- Indicates ascending infection (bladder to kidney)
Dosage Guidelines
- Acute UTI: 30C potency, 3-4 pellets dissolved under the tongue, every 1-4 hours depending on severity; reduce frequency as improvement occurs
- Subacute/recurring: 200C, once or twice daily
- Constitutional/chronic (RUTIs): Higher potencies (1M) under a qualified homeopath's supervision
- Stop the remedy when symptoms significantly improve (homeopathic principle: do not continue unnecessarily)
Evidence Status
The published clinical evidence for homeopathy in UTIs is limited but exists at case-report level:
- A retrospective case series (Gaertner et al., 2020 - PMID: 31945769) reported benefit with individualised homeopathy in women with recurrent cystitis
- Case reports of antibiotic-resistant UTI managed with integrated homeopathic care (PMID: 31958866)
- No large RCTs exist; all available evidence is case-report or expert-opinion level
- A controlled RCT comparing homeopathy vs. placebo for RUTIs has been proposed as feasible in the literature
Summary: Remedy Selector
| Symptom Keynote | Remedy |
|---|---|
| Burning before + during + after urination, drops only | Cantharis |
| Stinging at last drops, no thirst, swelling | Apis mellifica |
| Post-coital UTI, drop rolling sensation | Staphysagria |
| Pain worst at END of urination, better standing | Sarsaparilla |
| Radiating/shooting pain, worse walking | Berberis vulgaris |
| Sudden onset after cold, anxiety | Aconitum |
| Irritable patient, chilly, constant urge | Nux vomica |
| Highly coloured urine, bladder sensitivity, cramping | Belladonna |
| Urine smells of violets, haematuria + kidney pain | Terebenthina |
Staging of breast cancer.
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I now have comprehensive data from multiple authoritative surgical textbooks. Here is the complete staging of breast cancer:
Staging of Breast Cancer
Breast cancer staging uses the TNM system of the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (UICC). The current standard is the 8th Edition (2017), which introduced a major innovation: staging now incorporates both anatomic factors (T, N, M) and prognostic/biologic factors.
Two Types of Staging in AJCC 8th Edition
| Type | Based On | Used When |
|---|---|---|
| Anatomic Staging | Tumour size (T), nodal status (N), metastasis (M) | Biomarker data unavailable; resource-limited settings |
| Prognostic Staging | TNM + Grade + ER/PR/HER2 + Oncotype DX score | Standard in countries where biomarkers are routinely tested |
T - Primary Tumour Classification
| Category | Definition |
|---|---|
| Tx | Primary tumour cannot be assessed |
| T0 | No evidence of primary tumour |
| Tis | Carcinoma in situ: DCIS, or Paget disease of nipple with no underlying tumour. Note: LCIS is now classified as a benign high-risk lesion, NOT as Tis |
| T1 | Tumour ≤ 20 mm in greatest dimension |
| - T1mi | Microinvasion: invasive focus ≤ 1 mm |
| - T1a | > 1 mm but ≤ 5 mm |
| - T1b | > 5 mm but ≤ 10 mm |
| - T1c | > 10 mm but ≤ 20 mm |
| T2 | Tumour > 20 mm but ≤ 50 mm |
| T3 | Tumour > 50 mm |
| T4 | Tumour of any size with direct extension to chest wall (not including pectoralis muscle alone) and/or skin changes |
| - T4a | Extension to chest wall |
| - T4b | Ulceration, skin oedema (including peau d'orange), or satellite skin nodules (satellite nodules must be separate from the primary tumour) |
| - T4c | Both T4a and T4b |
| - T4d | Inflammatory carcinoma - skin changes involving ≥ 1/3 of the breast skin (erythema, peau d'orange). Remains classified as T4d even if complete remission follows neoadjuvant chemotherapy |
N - Regional Lymph Node Classification
Regional nodes = ipsilateral axillary, internal mammary, infraclavicular, supraclavicular. Contralateral nodes or cervical nodes = distant metastasis (M1).
Clinical N (cN) - assessed by examination ± imaging
| Category | Definition |
|---|---|
| cNx | Regional lymph nodes cannot be assessed |
| cN0 | No regional lymph node metastases (by imaging/examination) |
| cN1 | Movable ipsilateral level I/II axillary lymph node(s) with metastases |
| cN2 | Fixed/matted ipsilateral axillary nodes (cN2a); or clinically detected ipsilateral internal mammary nodes without axillary involvement (cN2b) |
| cN3 | Metastases in infraclavicular nodes (cN3a); or internal mammary + axillary nodes (cN3b); or ipsilateral supraclavicular nodes (cN3c) |
Pathologic N (pN) - assessed after surgical resection/sentinel node biopsy
| Category | Definition |
|---|---|
| pN0 | No regional lymph node metastases histologically |
| pN0(i+) | Isolated tumour cells: clusters ≤ 0.2 mm |
| pN1mi | Micrometastases: > 0.2 mm but none > 2.0 mm (or > 200 cells) |
| pN1 | Metastases in 1-3 axillary nodes, and/or internal mammary nodes by SLN biopsy (not clinically detected) |
| pN2 | Metastases in 4-9 axillary nodes; or clinically detected internal mammary nodes without axillary involvement |
| pN3 | Metastases in ≥ 10 axillary nodes; or infraclavicular (level III) nodes; or clinically detected internal mammary nodes + ≥1 positive axillary node; or >3 axillary nodes + internal mammary micrometastases; or ipsilateral supraclavicular nodes |
M - Distant Metastasis
| Category | Definition |
|---|---|
| M0 | No clinical or radiographic evidence of distant metastasis |
| cM0(i+) | Circulating tumour cells or disseminated tumour cells in bone marrow (≤ 0.2 mm) detected molecularly/microscopically; no clinical symptoms |
| M1 | Distant metastasis - common sites: bone, lung, liver, brain |
Anatomic Stage Grouping (AJCC 8th Edition)
| Stage | T | N | M |
|---|---|---|---|
| Stage 0 | Tis | N0 | M0 |
| Stage IA | T1 (incl. T1mi) | N0 | M0 |
| Stage IB | T0 or T1 | N1mi | M0 |
| Stage IIA | T0 or T1 | N1 | M0 |
| T2 | N0 | M0 | |
| Stage IIB | T2 | N1 | M0 |
| T3 | N0 | M0 | |
| Stage IIIA | T0, T1, T2 | N2 | M0 |
| T3 | N1 or N2 | M0 | |
| Stage IIIB | T4 | N0, N1, or N2 | M0 |
| Stage IIIC | Any T | N3 | M0 |
| Stage IV | Any T | Any N | M1 |
Prognostic Staging: Additional Factors (AJCC 8th Edition)
The 8th edition was the first breast cancer staging system to incorporate nonanatomic factors directly into stage grouping. These modify the final assigned stage upward or downward:
| Factor | Detail |
|---|---|
| Histologic Grade | Nottingham grading system (Grade 1/2/3) - now standardised and required |
| ER status | Estrogen receptor (positive/negative by IHC) |
| PR status | Progesterone receptor (positive/negative) |
| HER2 status | HER2/neu amplification (positive/negative/equivocal) |
| Oncotype DX Recurrence Score | Multigene panel - the only multigene assay currently incorporated; applies to ER+/HER2- early-stage disease; score ≤ 25 in postmenopausal women with 1-3 positive nodes may allow omission of chemotherapy (RxPONDER trial) |
Effect: A tumour that is anatomically Stage II but is ER+/PR+/HER2-, low grade, with a low Oncotype DX score may be downstaged to a more favourable prognostic stage. Conversely, a triple-negative or HER2+ tumour may be upstaged prognostically.
Special Prefixes and Suffixes
| Notation | Meaning |
|---|---|
| cTNM | Clinical staging (pre-treatment; physical exam + imaging + biopsy) |
| pTNM | Pathologic staging (post-surgery; preferred when available) |
| ypTNM | Post-neoadjuvant therapy pathologic staging |
| rTNM | Recurrent tumour staging |
| pT(m)NM | Multiple synchronous primary tumours (m = multiple) |
| pCR | Pathologic complete response - absence of tumour in breast AND axillary nodes after neoadjuvant therapy |
Work-up for Staging (NCCN Guidelines)
| Stage | Investigations |
|---|---|
| Early (T1-T2, N0-N1) | Bilateral breast imaging (mammogram ± MRI); metastatic workup only if symptoms or raised ALP |
| Locally advanced (T3-T4 or N2-N3) | CE-CT chest/abdomen/pelvis + isotope bone scan; PET-CT with 18F-FDG may be used |
| All stages | ER, PR, HER2, Ki-67, grade from tumour biopsy |
Key Points - AJCC 8th Edition Summary
- LCIS is not a cancer - it is a benign high-risk lesion and no longer classified as Tis
- Invasion of dermis alone does not qualify as T4 (must involve chest wall or cause oedema/ulceration)
- Inflammatory carcinoma = T4d regardless of response to neoadjuvant therapy
- Satellite skin nodules must be separate from the primary tumour for T4b classification
- Paget disease of the nipple without an underlying tumour mass = Tis
- Tumour size should be measured to the nearest millimetre; tumours > 1 mm and < 2 mm are rounded to 2 mm
Sources: Mulholland & Greenfield's Surgery 7th Ed., p. 3926-3931; Bailey & Love's Surgery 28th Ed., p. 1222-1232; Sabiston Textbook of Surgery; Current Surgical Therapy 14th Ed., p. 781; Fischer's Mastery of Surgery 8th Ed., p. 1782-1783
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