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Urinary Retention

Essentials

  • Acute symptomatic urinary retention must be treated immediately at the health care setting where the patient is first encountered.
  • Considerable retention (above 1 000 ml) should be treated by cystostomy, indwelling catheter, or repeated catheterization.
  • Consider the patient's medication as a potential cause of retention (anticholinergic and sympathomimetic drugs) http://www.dynamed.com/condition/acute-urinary-retention-in-men#CAUSES__PHARMA.

Symptoms and signs

  • Lower abdominal pain (often absent in slowly developing retention)
  • Overflow incontinence or increased urinary frequency
  • Enlarged palpable bladder
  • Enlarged bladder by percussion

Aetiology

  • Benign prostatic hyperplasia Benign Prostatic Hyperplasia (BPH; suggested by age and DRE finding)
  • Postoperative retention
  • Urethral stricture
  • In women, rarely, urethral mucosal prolapse, uterine prolapse or myoma
  • Neurogenic causes (spinal cord injury, intervertebral disc herniation, multiple sclerosis, diabetes, neuropathy caused by alcohol or toxic substances)
  • Functional causes (pain, tension, exposure to cold)
  • Legal and illegal drugs, alcohol
    • Anticholinergic drugs
    • Sympathomimetics, oral decongestants (pseudoephedrine) used mainly for rhinitis
    • Tricyclic antidepressants
    • Alcohol and other drugs of abuse

Treatment

Further investigations

  • In most cases (80%) of BPH-related retention the episode is the first occurrence of retention and therefore warrants follow-up.
  • A cleanly voided urine specimen and bacterial culture should be taken from all patients.
  • No other investigations are necessary if the patient had his first retention and there is a predisposing factor, e.g. alcohol, exposure to cold, postoperative state, or bed rest associated with an acute illness.
  • Retention without an evident cause and recurrent retention are indications for the following laboratory examinations: plasma creatinine http://www.dynamed.com/condition/acute-urinary-retention-in-men#ALPHA-ADRENERGIC_BLOCKERS, blood glucose, and, in men, plasma prostate-specific antigen (PSA).
    • If an increase of plasma creatinine concentration during retention was due to obstruction it normalizes rapidly.
    • Retention and catheterization raise PSA concentration. If the value is elevated, it should be controlled after 4-6 weeks.
  • Further urological investigations are indicated in recurrent urinary retention.

    References

    • Bengtsen MB, Farkas DK, Borre M et al. Acute urinary retention and risk of cancer: population based Danish cohort study. BMJ 2021;375():n2305. [PubMed]
    • Karavitakis M, Kyriazis I, Omar MI et al. Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. Eur Urol 2019;75(5):788-798. [PubMed]