Urinary retention resident survival guide
|Urinary retention Resident Survival Guide Microchapters|
|Urinary retention in women|
|Urinary Retention in Men|
Synonyms and Keywords:
Urinary retention can be defined as an inability to pass urine or incomplete emptying of the bladder. It is one of the most common presenting complaints encountered in the emergency department which can be acute or chronic. It is commonly seen in males as compared to females due to benign prostate hyperplasia. If undiagnosed or left untreated, this condition can be life-threatening as it may lead to kidney damage and severe urosepsis. Acute urinary retention can be extremely uncomfortable, brings the patient immediately in attention, and is initially managed by urethral or suprapubic catheterization. Chronic urinary retention is often asymptomatic, not easily identified, and is linked to increased post void residual volume. A complete detailed history about current prescription, over the counter and herbal medications is necessary along with focused physical examination that must include neurological evaluation.
Urinary Retention in Women
Urinary retention is overall very rare in women and can be acute or chronic. Common causes include: 
- Nerve injury during surgery-For example Episiotomy-postoperative
- Medications-Atropine, Glycopyrrolate, Bupivacaine
- Fowler's syndrome
- Obstructive causes-Vaginal hematoma, Vaginal packing, Sling, Foreign body, Pelvic organ prolapse, Urethral injury
Urinary Retention in Men
Urinary retention is much more common in males with a male to female ratio being 13:1.
Causes of Acute urinary retention in men
❑ Obstructive causes
- ❑ Benign Prostate Hyperplasia
- ❑ Prostate or Bladder Carcinoma
- ❑ Constipation
- ❑ Urolithiasis
- ❑ Urethral Stricture
- ❑ Phimosis or Paraphimosis
❑ Infectious Causes
❑ Neurological Causes
- ❑ stroke
- ❑ spinal cord injury
- ❑ Demyelinating disorders-Guillain barre syndrome, diabetic neuropathy, Multiple sclerosis.
- ❑ Sympathomimetic alpha adrenergic agents-Phenylephrine
- ❑ Sympathomimetic beta adrenergic agents-Isoproterenol
- ❑ Antidepressants-Amitriptyline,Imipramine
- ❑ Antiarrhythmics-Quinidine, procainamide, Disopyramide
- ❑ Anticholinergics-Atropine, oxybutynin, glycopyrrolate
- ❑ Antiparkinsonian agents-Amantadine, trihexyphenidyl,levadopa, bromocriptine
- ❑ Antipsychotics-Haloperidol, fluphenazine
- ❑ Hormonal agents-estrogen, progesterone, testosterone
- ❑ Antihistamines-diphenhydramine, hydroxysine
- ❑ Antihypertensives-Hydralazine,nifedipine
- ❑ Others-indomethacin, morphine, dopamine, amphetamines
Causes of Chronic urinary retention in Men
❑ Neurological Causes
A detailed history and a thorough physical examination may help in diagnosing the cause behind urinary retention.
Volume of urine in first 10-15 minutes of catheterization or with bladder ultrasound?
❑ suggest urinary retention-keep catheter in place if >400 ml
Urinary retention unlikely
Acute urinary retention is treated with immediate bladder decompression with intermittent urethral catheterization or suprapubic catheterization regardless of the cause and gender. Further management depend upon the cause of retention.   
Management of Acute Urinary retention in Men with benign prostate hyperplasia
Clean intermittent Urethral Self Cathterization
Admit the patient and give alpha blocker(for example-alfuzosin) plus TwoC for 2 days
|Suprapubic catheterization- Admit if urosepsis, dehydration or signs of renal failure|
follow patient with alpha blocker if uncomplicated BPH OR discuss for elective surgery TURP if complicated BPH
recatheterize and discuss TURP
If recurrent urinary retention-repeat alpha blocker and TwoC
|POSTOPERATIVE URINARY RETENTION|
|Use of alpha blocker alfuzosin if known risk factors e.g Diabetes, renal failure, BPH, elderly age||If using I/V fluids it is necessary to catheterize to prevent POUR||Early ambulation and judicious use of systemic opioids can prevent POUR||Catheterization and start alpha blocker tamsulosin if not already started|
|TwoC after 1-3 days of catheterization and if patient fail to void refer to outpatient urology consultation|
- Keep a close eye on the patient for dehydration and metabolic abnormalities which may result from post obstructive diuresis.
- Perform suprapubic catheterization in patients who had recent surgery and it should be ultrasound-guided.
- Do admit the patient with urosepsis, renal failure, electrolyte imbalance, malignancy, or acute myelopathy.
- It is must to educate the patient about catheter care and urine output monitoring.
- Do not perform urethral catheterization if the patient had a recent urologic surgery such as radical prostatectomy or urethral reconstruction.
- Do not start antibiotics until and unless the infection is confirmed.
- Catheterization in Men with BPH should not be more than 7 days.
- Serlin DC, Heidelbaugh JJ, Stoffel JT (2018). "Urinary Retention in Adults: Evaluation and Initial Management". Am Fam Physician. 98 (8): 496–503. PMID 30277739.
- Mevcha A, Drake MJ (2010). "Etiology and management of urinary retention in women". Indian J Urol. 26 (2): 230–5. doi:10.4103/0970-1591.65396. PMC 2938548. PMID 20877602.
- Roehrborn CG (2005). "Acute urinary retention: risks and management". Rev Urol. 7 Suppl 4: S31–41. PMC 1477606. PMID 16986053.
- Fitzpatrick JM, Desgrandchamps F, Adjali K, Gomez Guerra L, Hong SJ, El Khalid S; et al. (2012). "Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia". BJU Int. 109 (1): 88–95. doi:10.1111/j.1464-410X.2011.10430.x. PMC 3272343. PMID 22117624.
- Muruganandham K, Dubey D, Kapoor R (2007). "Acute urinary retention in benign prostatic hyperplasia: Risk factors and current management". Indian J Urol. 23 (4): 347–53. doi:10.4103/0970-1591.35050. PMC 2721562. PMID 19718286.