Register / Log in

Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Urinary retention

Last updated: January 6, 2021

Summary

Urinary retention is the inability to voluntarily empty the bladder. The causes can be either mechanical (e.g., benign prostatic hyperplasia, tumors, urethral strictures) or functional (e.g., detrusor underactivity due to peripheral neuropathy, anticholinergic drugs). Patients with acute urinary retention (AUR) present with a sudden, painful inability to void and a tender, distended bladder on palpation. Patients with chronic urinary retention (CUR) are typically unable to void completely but do not experience pain. AUR is usually diagnosed clinically and is considered an urological emergency. Therefore, urgent bladder catheterization should precede diagnostics. These include renal function tests to assess for renal damage (obstructive nephropathy) and ultrasound of the kidneys, ureter, and bladder to identify the underlying cause and possible complications (e.g., hydroureteronephrosis). Further evaluation depends on the patient history and physical examination. Treating the underlying cause (e.g., alpha adrenergics and/or TURP for BPH) is essential to prevent recurrence and complications due to urinary retention, such as UTI, nephrolithiasis, and renal failure.

Etiology

Mechanical obstruction

Functional obstruction

References:[1][2][3][3][4][5][6][7]

Clinical features

Acute urinary retention Chronic urinary retention
Etiology
Clinical features
  • More common in men, esp. > 70 years of age
  • Sudden onset
  • Painful inability to void
  • Suprapubic pain/discomfort
  • Palpable bladder
  • Patient is restless and distressed.

Physical examination

Complications

References:[8][9][10][11]

Subtypes and variants

Urethral stricture

References:[13]

Diagnostics

AUR is a urological emergency and urgent bladder catheterization should precede any further investigations. If the diagnosis is uncertain, abdominal ultrasound/bladder scan should be performed first to assess bladder volume. In patients with postoperative AUR, further investigations are usually not needed.

Laboratory studies

Imaging

Further investigations

AUR is a urological emergency and requires urgent bladder catheterization before any further investigations are performed!
References:[1][14][15][16][17][18][19]

Treatment

Urgent complete bladder catheterization

In all patients with acute or acute on chronic urinary retention (before further diagnostics)

Treatment of the underlying cause

In all patients with acute or chronic urinary retention:

See “ Posterior urethral valves”, “Genitourinary trauma”, and “Treatment of lower urinary tract obstruction” in “ Urinary tract obstruction” for information on the management of other causative factors.

References:[1][2][8][20][21][22][23]

References

  1. Selius BA, Subedi R. Urinary Retention in Adults: Diagnosis and Initial Management. Am Fam Physician. 2008; 77 (5): p.643-650.
  2. Miyamae K, Otsuka T, Otsuka Y, Nagayoshi M, Hamada Y. Clinical study of bladder tamponade resulting from clots of blood [Article in Japanese]. Nippon Hinyokika Gakkai Zasshi. 2006; 97 (5): p.743-747.
  3. Crain EF, Gershel JC, Cunningham SJ. Clinical Manual of Emergency Pediatrics. Cambridge University Press ; 2010
  4. Urinary bladder tamponade (blood clots in the bladder). http://www.ebm-guidelines.com/go/ebm/ebm00239.html. Updated: March 21, 2016. Accessed: March 14, 2017.
  5. Ali RA. Management of diabetic neuropathy. Malays J Med Sci. 2003; 10 (2): p.27-30.
  6. Verhamme KMC, Miriam M, Stricker BHCh, Bosch R. Drug-Induced Urinary Retention: Incidence, Management and Prevention. Drug Saf. 2008; 31 (5): p.373-388. doi: 10.2165/00002018-200831050-00002 . | Open in Read by QxMD
  7. Barrisford GW, Steele GS. Acute urinary retention. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/acute-urinary-retention.Last updated: September 21, 2015. Accessed: March 14, 2017.
  8. Kalejaiye O, Speakman MJ. Management of Acute and Chronic Retention in Men. Eur Urol Suppl. 2009; 8 (6): p.523–529. doi: 10.1016/j.eursup.2009.02.002 . | Open in Read by QxMD
  9. Acute urinary retention (AUR) in adult males.
  10. non-neurogenic chronic Urinary Retention: consensus Definition Management Strategies, and Future Opportunities.
  11. Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points. J Urol. 2017; 198 (1): p.153-160. doi: 10.1016/j.juro.2017.01.075 . | Open in Read by QxMD
  12. Aliasgari M, Soleimani M, Hosseini moghaddam SM. The effect of acute urinary retention on serum prostate-specific antigen level. Urol J. 2005; 2 (2): p.89-92.
  13. Mustonena S, Ala-Houhalab IO, Vehkalahtic P, Laippalad P, Tammelaa TLJ. Kidney ultrasound and Doppler ultrasound findings during and after acute urinary retention. Eur J Ultrasound. 2001; 12 (3): p.189–196. doi: 10.1016/S0929-8266(00)00115-4 . | Open in Read by QxMD
  14. Lukacz ES, Sampselle C, Gray M, et al. A healthy bladder: a consensus statement. Int J Clin Pract. 2011; 65 (10): p.1026-1036. doi: 10.1111/j.1742-1241.2011.02763.x . | Open in Read by QxMD
  15. Kumar V, Dhabalia JV, Nelivigi GG, Punia MS, Suryavanshi M. Age, gender, and voided volume dependency of peak urinary flow rate and uroflowmetry nomogram in the Indian population. Indian J Urol. 2009; 25 (4): p.461-466. doi: 10.4103/0970-1591.57912 . | Open in Read by QxMD
  16. Dorsher PT, Mcintosh PM. Neurogenic bladder. Adv Urol. 2012 . doi: 10.1155/2012/816274 . | Open in Read by QxMD
  17. Neurogenic Bladder. http://www.msdmanuals.com/professional/genitourinary-disorders/voiding-disorders/neurogenic-bladder. Updated: September 1, 2016. Accessed: February 22, 2017.
  18. Willette PA, Coffield S. Current trends in the management of difficult urinary catheterizations. West J Emerg Med. 2012; 13 (6): p.472-478. doi: 10.5811/westjem.2011.11.6810 . | Open in Read by QxMD
  19. Basler J. Hemorrhagic Cystitis. Hemorrhagic Cystitis. New York, NY: WebMD. http://emedicine.medscape.com/article/2056130. Updated: October 5, 2016. Accessed: February 22, 2017.
  20. Koc S, Hagglund H, Ireton RC, Perez-Simon JA, Collins SJ, Appelbaum FR. Case Report: Successful treatment of severe hemorrhagic cystitis with cystectomy following matched donor allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2000; 26 (8): p.899-901.
  21. West DA, Cummings JM, Longo WE, Virgo KS, Johnson FE, Parra RO. Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury. Urology. 1999; 53 (2): p.292-297.
  22. Rourke K, Hickle J. The Clinical Spectrum of the Presenting Signs and Symptoms of Anterior Urethral Stricture: Detailed Analysis of a Single Institutional Cohort. Urology. 2012; 79 (5): p.1163-1167. doi: 10.1016/j.urology.2012.01.044 . | Open in Read by QxMD
  23. Broghammer JA. Urethral Strictures in Males. Urethral Strictures in Males. New York, NY: WebMD. http://emedicine.medscape.com/article/450903. Updated: November 21, 2015. Accessed: March 15, 2017.