Diagnosis
History and examination by a clinician for characteristic signs and symptoms are sufficient in many cases in ruling out systemic causes of venous hypertension such as hypervolemia and heart failure. A duplex ultrasound (doppler ultrasonography and b-mode) can detect venous obstruction or valvular incompetence as the cause, and is used for planning venous ablation procedures, but it is not necessary in suspected venous insufficiency where surgical intervention is not indicated.Insufficiency within a venous segment is defined as reflux of more than 0.5 seconds with distal compression. Invasive venography can be used in patients who may require surgery or have suspicion of venous stenosis. Other modalities that may be employed are: ankle-brachial index to exclude arterial pathology, air or photoplethysmography, intravascular ultrasound, and ambulatory venous pressures, which provides a global assessment of venous competence. Venous plethysmography can assess for reflux and muscle pump dysfunction but the test is laborious and rarely done.The venous filling time after the patient is asked to stand up from a seated position also is used to assess for CVI. Rapid filling of the legs less than 20 seconds is abnormal. Classification
CEAP classification is based on Clinical, Etiological (causal), Anatomical, and Pathophysiological factors. According to Widmer Classification for assessment of chronic venous insufficiency (CVI), diagnosis of chronic venous insufficiency is clearly differentiated from varicose veins.
Surgery related: Operative times longer than 2 hours may lead to an increased risk of postoperative urinary retention 3-fold. Postoperative pain. Chronic
Chronic urinary retention that is due to bladder blockage which can either be as a result of muscle damage or neurological damage. If the retention is due to neurological damage, there is a disconnect between the brain to muscle communication, which can make it impossible to completely empty the bladder. If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.The most common cause of chronic urinary retention is BPH. BPH is a result of the ongoing process of testosterone being converted to dihydrotestosterone which stimulates prostate growth. Over a persons lifetime, the prostate experiences constant growth due to the conversion of testosterone to dihydrotestosterone. This can cause the prostate to push on the urethra and block it, which can lead to urinary retention. Other
Tethered spinal cord syndrome. Psychogenic causes – psychosocial stresses, fear associated with urination, paruresis ("shy bladder syndrome") – in extreme cases, urinary retention can result. Consumption of some psychoactive substances, mainly stimulants, such as MDMA or amphetamine. Use of NSAIDs, or drugs with anticholinergic properties. Stones or metastases, which can theoretically appear anywhere along the urinary tract, but vary in frequency depending on anatomy. Muscarinic antagonists such as atropine and scopolamine. Malfunctioning artificial urinary sphincter. Diagnosis
Analysis of urine flow may aid in establishing the type of micturition (urination) abnormality.