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Urinary retention

Last updated: September 16, 2021

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Urinary retention is the inability to voluntarily empty the bladder. The causes can be either mechanical (e.g., benign prostatic hyperplasia, tumors, urethral strictures) or functional (e.g., detrusor underactivity due to peripheral neuropathy, anticholinergic drugs). Patients with acute urinary retention (AUR) present with a sudden, painful inability to void and a tender, distended bladder on palpation. Patients with chronic urinary retention (CUR) are typically unable to void completely but do not experience pain. AUR is usually diagnosed clinically and is considered an urological emergency. Therefore, urgent bladder catheterization should precede diagnostics. These include renal function tests to assess for renal damage (obstructive nephropathy) and ultrasound of the kidneys, ureter, and bladder to identify the underlying cause and possible complications (e.g., hydroureteronephrosis). Further evaluation depends on the patient history and physical examination. Treating the underlying cause (e.g., alpha adrenergics and/or TURP for BPH) is essential to prevent recurrence and complications due to urinary retention, such as UTI, nephrolithiasis, and renal failure.

Mechanical obstruction

Functional obstruction

Acute vs. chronic urinary retention
Acute urinary retention Chronic urinary retention
Etiology
Clinical features
  • More common in men, esp. > 70 years of age [7]
  • Sudden onset
  • Painful inability to void
  • Suprapubic pain/discomfort
  • Palpable bladder
  • Patient is restless and distressed.

Physical examination

Urethral stricture

AUR is a urological emergency and urgent bladder catheterization should precede any further investigations. If the diagnosis is uncertain, abdominal ultrasound/bladder scan should be performed first to assess bladder volume. In patients with postoperative AUR, further investigations are usually not needed. [1]

Laboratory studies

Imaging

Further investigations

AUR is a urological emergency and requires urgent bladder catheterization before any further investigations are performed!

Urgent complete bladder catheterization [10][17]

In all patients with acute or acute on chronic urinary retention (before further diagnostics)

Treatment of the underlying cause [10][17][18][19]

In all patients with acute or chronic urinary retention:

See “Posterior urethral valves”, “Genitourinary trauma”, and “Treatment of lower urinary tract obstruction” in “ Urinary tract obstruction” for information on the management of other causative factors.

Complications of urinary retention

Complications of bladder decompression [20]

Complications of bladder decompression via catheterization are rare and usually self-limiting.

We list the most important complications. The selection is not exhaustive.

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