Acute urinary retention

INTRODUCTION

Acute urinary retention (AUR) is the most common urologic emergency. It occurs most frequently in men over age 60, and is often the result of benign prostatic hyperplasia (BPH) [1-4]. The natural history of BPH is one of clinical progression over time. Over a five year period, AUR occurs in approximately 10 percent of men over the age of 70 and almost one-third of men in their 80's [1,3,5]. (See "Epidemiology and pathogenesis of benign prostatic hyperplasia", section on 'Epidemiology'.)

Increased longevity has resulted in a trend toward increasing prevalence of BPH and related disorders. It is therefore important for medical professionals to become familiar with management of acute urinary retention, related to BPH as well as other etiologies.

The risk factors, acute management, medical therapy, and surgical intervention for patients who develop acute urinary retention will be reviewed here. The diagnosis and treatment of BPH, and the diagnosis of acute and chronic urinary retention, 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" and "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis".)

ETIOLOGY

Acute urinary retention is most often secondary to obstruction, but may also be related to trauma, medication, neurologic disease, infection, and occasionally psychologic issues [6]. Often, especially in the older patient, several underlying factors interact to precipitate acute urinary retention. In one series of male patients, the identified causes of AUR were [2]:

Benign prostatic hyperplasia (BPH) — 53 percent

                    

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Literature review current through: Aug 2014. | This topic last updated: Nov 21, 2013.
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References
Top
  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.
  2. Murray K, Massey A, Feneley RC. Acute urinary retention--a urodynamic assessment. Br J Urol 1984; 56:468.
  3. Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997; 158:481.
  4. 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.
  5. Contemporary Urology. Urology Times 2005 Fact Book. Advanstar Medical Economics Healthcare Communications Secondary Research Services 2005.
  6. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am 2001; 19:591.
  7. Powell PH, Smith PJ, Feneley RC. The identification of patients at risk from acute retention. Br J Urol 1980; 52:520.
  8. Thomas K, Chow K, Kirby RS. Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis 2004; 7:32.
  9. 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.
  10. Emberton M, Anson K. Acute urinary retention in men: an age old problem. BMJ 1999; 318:921.
  11. Choong S, Emberton M. Acute urinary retention. BJU Int 2000; 85:186.
  12. 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.
  13. Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf 2008; 31:373.
  14. Raz S, Zeigler M, Caine M. Pharmacological receptors in the prostate. Br J Urol 1973; 45:663.
  15. Barry MJ, Fowler FJ Jr, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 1992; 148:1549.
  16. Kurita Y, Masuda H, Terada H, et al. Transition zone index as a risk factor for acute urinary retention in benign prostatic hyperplasia. Urology 1998; 51:595.
  17. 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.
  18. Nyman MA, Schwenk NM, Silverstein MD. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc 1997; 72:951.
  19. 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.
  20. Manikandan R, Srirangam SJ, O'Reilly PH, Collins GN. Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey. BJU Int 2004; 93:84.
  21. Allardice JT, Standfield NJ, Wyatt AP. Acute urinary retention: which catheter? Ann R Coll Surg Engl 1988; 70:366.
  22. 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.
  23. Horgan AF, Prasad B, Waldron DJ, O'Sullivan DC. Acute urinary retention. Comparison of suprapubic and urethral catheterisation. Br J Urol 1992; 70:149.
  24. Patel MI, Watts W, Grant A. The optimal form of urinary drainage after acute retention of urine. BJU Int 2001; 88:26.
  25. Oberst MT, Graham D, Geller NL, et al. Catheter management programs and postoperative urinary dysfunction. Res Nurs Health 1981; 4:175.
  26. Foster MC, Upsdell SM, O'Reilly PH. Urological myths. BMJ 1990; 301:1421.
  27. Osius, TG, Hynman, F Jr. Dynamics of acute urinary retention: A manometric, radiographic and clinical study. J Urol 1963; 90:702.
  28. 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.
  29. 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.
  30. Fitzpatrick JM, Kirby RS. Management of acute urinary retention. BJU Int 2006; 97 Suppl 2:16.
  31. 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.
  32. Taube M, Gajraj H. Trial without catheter following acute retention of urine. Br J Urol 1989; 63:180.
  33. 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.
  34. Caine M, Pfau A, Perlberg S. The use of alpha-adrenergic blockers in benign prostatic obstruction. Br J Urol 1976; 48:255.
  35. Zeif HJ, Subramonian K. Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. Cochrane Database Syst Rev 2009; :CD006744.
  36. de Mey C. alpha(1)-blockers for BPH: are there differences? Eur Urol 1999; 36 Suppl 3:52.
  37. 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.
  38. 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.
  39. Andersen JT, Nickel JC, Marshall VR, et al. Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia. Urology 1997; 49:839.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. Higgins PM, French ME, Chadalavada VS. Management of acute retention of urine: a reappraisal. Br J Urol 1991; 67:365.
  45. 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.
  46. 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.
  47. Ogiste JS, Cooper K, Kaplan SA. Are stents still a useful therapy for benign prostatic hyperplasia? Curr Opin Urol 2003; 13:51.
  48. 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.
  49. Ramsey S, Palmer M. The management of female urinary retention. Int Urol Nephrol 2006; 38:533.
  50. Adam RA, Taghechian S. Acute urinary retention caused by a large hydrosalpinx. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:691.
  51. 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.
  52. 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.
  53. Glück G, Mitulescu G, Ungureanu D, Stîngu C. [Acute urinary retention in primary vaginal carcinoma: therapeutic approach]. Chirurgia (Bucur) 2007; 102:349.
  54. Gupta S, Manyonda IT. Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol 2009; 23:609.
  55. Haskal ZJ, Armijo-Medina H. Uterine fibroid embolization for patients with acute urinary retention. J Vasc Interv Radiol 2008; 19:1503.
  56. Chang JW, Yang LY, Wang HH, et al. Acute urinary retention as the presentation of imperforate hymen. J Chin Med Assoc 2007; 70:559.
  57. 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.
  58. Yellamareddygari S, Ahluwalia A. Acute vulval oedema with urinary retention in pregnancy. J Obstet Gynaecol 2006; 26:816.