Acute urinary retention
- Glen W Barrisford, MD, MS
Glen W Barrisford, MD, MS
- Instructor in Surgery
- Harvard Medical School
- 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 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".)
Acute urinary retention is most often secondary to obstruction, but may also be related to trauma, medication, neurologic disease, infection, and occasionally psychologic issues . 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 :
●Benign prostatic hyperplasia (BPH) — 53 percent
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- Outflow obstruction
- Neurologic impairment
- RISK FACTORS
- CLINICAL PRESENTATION
- Post-void residual volume
- ACUTE MANAGEMENT
- Initial management
- - Intermittent catheterization
- - Rate of bladder decompression
- Indications for hospitalization
- Trial without catheter
- - Duration of catheterization
- - Medical management
- SURGICAL THERAPY
- URINARY RETENTION IN WOMEN
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS