Urinary retention

Last updated: December 7, 2023

Summarytoggle arrow icon

Urinary retention is the inability to voluntarily empty the bladder. The cause 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 a urological emergency. Therefore, urgent bladder catheterization should precede diagnostics. Diagnostics 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., with alpha blockers and/or TURP for benign prostatic hyperplasia) is essential to prevent recurrence and complications of urinary retention (e.g., UTI, obstructive nephropathy).

Etiologytoggle arrow icon

Mechanical bladder outlet obstruction [1][2]

Bladder obstruction

Urethral obstruction

Extrinsic obstruction

Functional bladder outlet obstruction

Neurogenic lower urinary tract dysfunction (neurogenic bladder) [3][4][5]

Neurogenic lower urinary tract dysfunction is caused by disruption in the innervation of the detrusor and/or urethral sphincter and is commonly classified by anatomical location.

Drug-induced urinary retention [1][6]


Clinical featurestoggle arrow icon

Acute vs. chronic urinary retention
Acute urinary retention Chronic urinary retention
Clinical features
  • More common in men, esp. > 70 years of age [8]
  • Sudden onset
  • Painful inability to void
  • Suprapubic pain/discomfort
  • Palpable bladder
  • Patient is restless and distressed.

Physical examination

Initial management of acute urinary retentiontoggle arrow icon

Approach [1][2]

In patients with pelvic or perineal trauma or a prior history of urethral strictures, consider immediate urology consult before attempting bladder catheterization. [1]

Rapid and complete bladder decompression is recommended for all patients with AUR, as gradual decompression has not been shown to prevent complications. [2][11]

Disposition [1][2]

  • Consider hospital admission for patients with significant comorbidities, neurological deficits, obstructive nephropathy, or UTI.
  • Discharge otherwise healthy patients with an indwelling catheter and arrange an outpatient voiding trial 3–7 days later. [2]
  • Refer patients to urology within 2–3 weeks if: [1]

Diagnosticstoggle arrow icon

If clinical features of AUR are present, perform urgent bladder catheterization before obtaining diagnostic studies. [1][2]

Initial diagnostics [1][2]

Additional diagnostics [1]

Additional diagnostics should be obtained in consultation with urology to confirm the diagnosis, determine the etiology of urinary retention, and rule out differential diagnoses.

Treatmenttoggle arrow icon

Treatment of the underlying cause is indicated for AUR and CUR. For immediate management of AUR and urgent bladder decompression, see “Initial management of acute urinary retention.”

Mechanical bladder outlet obstruction

Functional bladder outlet obstruction

Complicationstoggle arrow icon

Complications of urinary retention

Complications of bladder decompression [2]

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

Postobstructive diuresis [16]

Other complications of decompression

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

Referencestoggle arrow icon

  1. Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician. 2018; 98 (8): p.496-503.
  2. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  3. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol. 2021; 206 (5): p.1097-1105.doi: 10.1097/ju.0000000000002235 . | Open in Read by QxMD
  4. Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015; 14 (7): p.720-732.doi: 10.1016/s1474-4422(15)00070-8 . | Open in Read by QxMD
  5. Panicker JN. Neurogenic Bladder: Epidemiology, Diagnosis, and Management. Semin Neurol. 2020; 40 (05): p.569-579.doi: 10.1055/s-0040-1713876 . | Open in Read by QxMD
  6. Verhamme KMC, Miriam M, Stricker BHCh, Bosch R. Drug-Induced Urinary Retention: Incidence, Management and Prevention. Drug Saf. 2008; 31 (5): p.373-388.doi: 10.2165/00002018-200831050-00002 . | Open in Read by QxMD
  7. Cash H, Wendler JJ, Minore A, Goumas IK, Cindolo L. Primary bladder neck obstruction in men—new perspectives in physiopathology. Prostate Cancer Prostatic Dis. 2023.doi: 10.1038/s41391-023-00691-1 . | Open in Read by QxMD
  8. Kalejaiye O, Speakman MJ. Management of Acute and Chronic Retention in Men. Eur Urol Suppl. 2009; 8 (6): p.523–529.doi: 10.1016/j.eursup.2009.02.002 . | Open in Read by QxMD
  9. Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points. J Urol. 2017; 198 (1): p.153-160.doi: 10.1016/j.juro.2017.01.075 . | Open in Read by QxMD
  10. Aliasgari M, Soleimani M, Hosseini moghaddam SM. The effect of acute urinary retention on serum prostate-specific antigen level. Urol J. 2005; 2 (2): p.89-92.
  11. Stöhrer M, Blok B, Castro-Diaz D, et al. EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction. Eur Urol. 2009; 56 (1): p.81-88.doi: 10.1016/j.eururo.2009.04.028 . | Open in Read by QxMD
  12. Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol. 2016; 263 (12): p.2555-2564.doi: 10.1007/s00415-016-8212-2 . | Open in Read by QxMD
  13. Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016; 5 (1): p.127-35.doi: 10.3978/j.issn.2223-4683.2016.01.08 . | Open in Read by QxMD
  14. Halbgewachs C, Domes T. Postobstructive diuresis: pay close attention to urinary retention. Can Fam Physician. 2015; 61 (2): p.137-42.
  15. Boettcher S, Brandt AS, Roth S, Mathers MJ, Lazica DA. Urinary Retention: Benefit of Gradual Bladder Decompression - Myth or Truth? A Randomized Controlled Trial. Urol Int. 2013; 91 (2): p.140-144.doi: 10.1159/000350943 . | Open in Read by QxMD
  16. Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014.doi: 10.1002/14651858.cd006744.pub3 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer