Urinary retention resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kanwal Khamuani

Urinary retention Resident Survival Guide Microchapters
Urinary retention in women
Urinary Retention in Men

Synonyms and keywords:


Urinary retention is 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, and 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, 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: [1]

Urinary Retention in Men

Urinary retention is more common in males, with a male to female ratio of 13:1.

Causes of Acute urinary retention in men
❑ Obstructive causes

Benign Prostate Hyperplasia
Prostate or Bladder Carcinoma
Urethral Stricture
Phimosis or Paraphimosis

❑ Infectious Causes

Genital herpes

❑ Neurological Causes

spinal cord injury
Demyelinating disorders-Guillain barre syndrome, diabetic neuropathy, Multiple sclerosis.

Detrusor Muscle Dysfunction
❑ Medications

Sympathomimetic alpha adrenergic agents-Phenylephrine
Sympathomimetic beta adrenergic agents-Isoproterenol
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
❑ Others-indomethacin, morphine, dopamine, amphetamines

Causes of Chronic urinary retention in Men
❑ Neurological Causes

Diabetic neuropathy
peripheral neuropathy
Spinal injury

Detrusor Muscle Dysfunction


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?
<200 ml
❑ 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.[3] [4] [5] [2]

Abbreviations: TwoC: trial without catheter; BPH: Benign prostate hyperplasia; TURP: Transurethral resection of prostate;POUR: postoperative urinary retention;I/V: Intravenous

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

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




  1. Serlin DC, Heidelbaugh JJ, Stoffel JT (2018). "Urinary Retention in Adults: Evaluation and Initial Management". Am Fam Physician. 98 (8): 496–503. PMID 30277739.
  2. 2.0 2.1 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.
  3. Roehrborn CG (2005). "Acute urinary retention: risks and management". Rev Urol. 7 Suppl 4: S31–41. PMC 1477606. PMID 16986053.
  4. 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.
  5. 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.