Acute urinary retention
- Glen W Barrisford, MD, MS
Glen W Barrisford, MD, MS
- Director of Urologic Oncology
- Santa Rosa Medical Center
- Kaiser Permanente
- Graeme S Steele, MBBCh, FCS
Graeme S Steele, MBBCh, FCS
- Assistant Professor of Surgery
- Harvard Medical School
- Section Editors
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
Acute urinary retention (AUR) is the inability to voluntarily pass urine. It is the most common urologic emergency . In men, AUR is most often secondary to benign prostatic hyperplasia (BPH); AUR is rare in women [2,3].
This topic will review the epidemiology, pathogenesis and etiology, clinical presentation, evaluation, diagnosis, acute management, and subsequent evaluation and management of AUR. The diagnosis and treatment of BPH are discussed separately. (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia" and "Medical treatment of benign prostatic hyperplasia" and "Transurethral procedures for treating benign prostatic hyperplasia".)
Acute urinary retention (AUR) is common in men. The incidence increases with age, occurring most frequently in men over age 60 [2-5]. It is estimated that over a five-year period, approximately 10 percent of men over the age of 70 and almost one-third of men in their 80s will develop AUR [2,3,6].
PATHOGENESIS AND ETIOLOGIES
A variety of pathophysiologic mechanisms may be responsible for the development of acute urinary retention (AUR). These mechanisms may overlap within any specific etiology.
- Marshall JR, Haber J, Josephson EB. An evidence-based approach to emergency department management of acute urinary retention. Emerg Med Pract 2014; 16:1.
- Fong YK, Milani S, Djavan B. Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia. Curr Opin Urol 2005; 15:35.
- Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997; 158:481.
- Murray K, Massey A, Feneley RC. Acute urinary retention--a urodynamic assessment. Br J Urol 1984; 56:468.
- Kaplan SA, Wein AJ, Staskin DR, et al. Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol 2008; 180:47.
- Contemporary Urology. Urology Times 2005 Fact Book. Advanstar Medical Economics Healthcare Communications Secondary Research Services 2005.
- Ramsey S, Palmer M. The management of female urinary retention. Int Urol Nephrol 2006; 38:533.
- Klarskov P, Andersen JT, Asmussen CF, et al. Acute urinary retention in women: a prospective study of 18 consecutive cases. Scand J Urol Nephrol 1987; 21:29.
- Choong S, Emberton M. Acute urinary retention. BJU Int 2000; 85:186.
- Powell PH, Smith PJ, Feneley RC. The identification of patients at risk from acute retention. Br J Urol 1980; 52:520.
- Thomas K, Chow K, Kirby RS. Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis 2004; 7:32.
- Waterhouse N, Beaumont AR, Murray K, et al. Urinary retention after total hip replacement. A prospective study. J Bone Joint Surg Br 1987; 69:64.
- Emberton M, Anson K. Acute urinary retention in men: an age old problem. BMJ 1999; 318:921.
- Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth 2005; 95:584.
- Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am 2001; 19:591.
- Roehrborn CG, McConnell JD, Lieber M, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999; 53:473.
- Adam RA, Taghechian S. Acute urinary retention caused by a large hydrosalpinx. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:691.
- Chauleur C, Vulliez L, Seffert P. Acute urine retention in early pregnancy resulting from fibroid incarceration: proposition for management. Fertil Steril 2008; 90:1198.e7.
- Ding DC, Hwang KS. Female acute urinary retention caused by anterior deflection of the cervix which was augmented by an uterine myoma. Taiwan J Obstet Gynecol 2008; 47:350.
- Glück G, Mitulescu G, Ungureanu D, Stîngu C. [Acute urinary retention in primary vaginal carcinoma: therapeutic approach]. Chirurgia (Bucur) 2007; 102:349.
- Gupta S, Manyonda IT. Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol 2009; 23:609.
- Haskal ZJ, Armijo-Medina H. Uterine fibroid embolization for patients with acute urinary retention. J Vasc Interv Radiol 2008; 19:1503.
- Chang JW, Yang LY, Wang HH, et al. Acute urinary retention as the presentation of imperforate hymen. J Chin Med Assoc 2007; 70:559.
- Topcuoglu MA, Koc O, Duran B, Donmez M. Labial fusion causing acute urinary retention in a young adult: a case report. Aust N Z J Obstet Gynaecol 2009; 49:115.
- Yellamareddygari S, Ahluwalia A. Acute vulval oedema with urinary retention in pregnancy. J Obstet Gynaecol 2006; 26:816.
- Wu CQ, Lefebvre G, Frecker H, Husslein H. Urinary retention and uterine leiomyomas: a case series and systematic review of the literature. Int Urogynecol J 2015; 26:1277.
- Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf 2008; 31:373.
- Raz S, Zeigler M, Caine M. Pharmacological receptors in the prostate. Br J Urol 1973; 45:663.
- Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician 2008; 77:643.
- Nyman MA, Schwenk NM, Silverstein MD. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc 1997; 72:951.
- Patel MI, Watts W, Grant A. The optimal form of urinary drainage after acute retention of urine. BJU Int 2001; 88:26.
- Horgan AF, Prasad B, Waldron DJ, O'Sullivan DC. Acute urinary retention. Comparison of suprapubic and urethral catheterisation. Br J Urol 1992; 70:149.
- Ichsan J, Hunt DR. Suprapubic catheters: a comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention. Aust N Z J Surg 1987; 57:33.
- Oberst MT, Graham D, Geller NL, et al. Catheter management programs and postoperative urinary dysfunction. Res Nurs Health 1981; 4:175.
- Boettcher S, Brandt AS, Roth S, et al. Urinary retention: benefit of gradual bladder decompression - myth or truth? A randomized controlled trial. Urol Int 2013; 91:140.
- Foster MC, Upsdell SM, O'Reilly PH. Urological myths. BMJ 1990; 301:1421.
- Pickard R, Emberton M, Neal DE. The management of men with acute urinary retention. National Prostatectomy Audit Steering Group. Br J Urol 1998; 81:712.
- Klarskov P, Andersen JT, Asmussen CF, et al. Symptoms and signs predictive of the voiding pattern after acute urinary retention in men. Scand J Urol Nephrol 1987; 21:23.
- Caine M, Pfau A, Perlberg S. The use of alpha-adrenergic blockers in benign prostatic obstruction. Br J Urol 1976; 48:255.
- 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; :CD006744.
- de Mey C. alpha(1)-blockers for BPH: are there differences? Eur Urol 1999; 36 Suppl 3:52.
- Fitzpatrick JM, Kirby RS. Management of acute urinary retention. BJU Int 2006; 97 Suppl 2:16.
- Lucas MG, Stephenson TP, Nargund V. Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int 2005; 95:354.
- McNeill SA, Hargreave TB, Members of the Alfaur Study Group. Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention. J Urol 2004; 171:2316.
- McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group. Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. Urology 2005; 65:83.
- McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998; 338:557.
- McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349:2387.
- Bruskewitz R, Girman CJ, Fowler J, et al. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology 1999; 54:670.
- Taube M, Gajraj H. Trial without catheter following acute retention of urine. Br J Urol 1989; 63:180.
- Djavan B, et al. Does prolonged catheter drainage improve the chance of recovering voluntary voiding after acute urinary retention of urine (AUR)? Eur Urol 1998; 33:110.
- Desgrandchamps F, De La Taille A, Doublet JD, RetenFrance Study Group. The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia. BJU Int 2006; 97:727.
- Wasson JH, Reda DJ, Bruskewitz RC, et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995; 332:75.
- Higgins PM, French ME, Chadalavada VS. Management of acute retention of urine: a reappraisal. Br J Urol 1991; 67:365.
- Isotalo T, Talja M, Välimaa T, et al. A pilot study of a bioabsorbable self-reinforced poly L-lactic acid urethral stent combined with finasteride in the treatment of acute urinary retention from benign prostatic enlargement. BJU Int 2000; 85:83.
- Ogiste JS, Cooper K, Kaplan SA. Are stents still a useful therapy for benign prostatic hyperplasia? Curr Opin Urol 2003; 13:51.
- Perry MJ, Roodhouse AJ, Gidlow AB, et al. Thermo-expandable intraprostatic stents in bladder outlet obstruction: an 8-year study. BJU Int 2002; 90:216.
- PATHOGENESIS AND ETIOLOGIES
- CLINICAL PRESENTATION
- ACUTE MANAGEMENT
- Options for bladder decompression
- - Urethral catheterization
- Indwelling catheter
- Clean intermittent catheterization
- - Suprapubic catheter
- Rate of decompression
- Complications of decompression
- Duration of catheterization
- Other treatments
- Indications for hospitalization
- SUBSEQUENT MANAGEMENT
- Benign prostatic hyperplasia
- - Medical management
- - Trial without a catheter
- - Surgical therapy
- Other conditions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS