Acute Urinary Retention

1. Acute urinary retention (AUR) is the sudden inability to pass urine. It is usually painful and
requires emergency treatment with a urinary catheter
2. Urinary retention is the inability to voluntarily urinate. Acute urinary retention is the sudden
and often painful inability to void despite having a full bladder.
3. Symptoms:
 History: Tender distended bladder, anuria, pain, fever, weight loss, sensory loss,
weakness
 Examinations:
o General: fever and signs of infection
o Abdominal: tender enlarged bladder with dullness to percussion above
symphysis pubis (level to the umbilicus)
o Genitourinary: in men look for phimosis or meatal stenosis as well as
urethral discharge and genital vesicles. In women look for vaginal
inflammation or infection, cystocele, rectocele or uterine prolapse as well as
pelvic mass
o Per rectum: retroverted gravid uterus, gynaecological malignancy
o Neurological: prolapsed disc or cord compression by checking lower limb
power and reflexes
4. Causes:
 In men: benign prostatic hyperplasia, meatal stenosis, penile constricting bands,
phimosis and prostate cancer. Prostatic abscess
 In women: prolapse, pelvic mass, gynaecological malignancy, uterine fibroid, ovarian
cyst. Vaginal lichen
 Both: bladder calculi, bladder cancer, faecal impaction, GI or retroperitoneal
malignancy, foreign body and stones.
 Drug related: opioids and anaesthetics, benzodiazepines, NSAIDs, Calcium channel
blockers, Antihistamines, Alcohol. Nsaids because it affects the production of
prostaglandins, a hormone essential for muscle function. (opioids increases the
sphincter tone of the urinary bladder via sympathetic overstimulation resulting in
increased bladder outlet resistance)
 Neurological:
o Autonomic or peripheral nerve (diabetes mellitus, pernicious anaemia,
poliomyelitis, spinal cord trauma)
o Brain: CVD, multiple sclerosis, neoplasm, Parkinson’s disease
o Spinal cord: spinal cord trauma, spinal stenosis, tumours
 Other:
o Men: penile trauma, fracture
o Women: postpartum complications, urethral sphincter

General causes:

 Traumatic instrumentation.
 Bladder overdistension.
 Drugs (particularly opioids).
 Iatrogenic - for example:
  Suburethral sling procedures for stress incontinence
 Posterior colporrhaphy [4]. Surgical procedures to repair pelvic organ prolapse)
 Decreased mobility and increased bed rest.

5. Investigations:
 Urinalysis: check for infection, haematuria, proteinuria, glucosuria
 MSU: urinary cultures
 Blood tests: FBC, U&E, creatinine, estimated glomerular filtration rate (EGFR),
Glucose, Prostate- specific antigen (PSA)- for AUR)
 Imaging:
o ultrasound (structural abnormalities and post void residual urine)
o CT scan (pelvic, abdominal or retroperitoneal mass causing extrinsic bladder
neck compression)
o MRI/CT brain scan- intracranial lesions (tumour, stroke, MS)
o MRI scan of the spine- disc prolapse, spinal tumours, MS
o Cystoscopy or retrograde cystourethrography or urodynamic studies- for
suspected retention

6. Management and treatment:

 INITIAL: Men with acute urinary tract retention should be immediately catheterised.
An alpha blocker should be offered before removal of catheter such as doxazosin,
tamsulosin hydrochloride or alfuzosin hydrochloride
 SECONDARY: this depends on the cause of AUR- if caused by prostatic enlargement
prostatic surgery within a few days (emergency or elective)
 Management: can give long term medical treatment such as (5-alpha reductase
inhibitors alone or in combination with alpha-blockers)

Chronic urinary retention

1. What is chronic urinary retention?
 Chronic retention of urine as a nonpainful bladder that remains palpable after voiding.

2. How is it defined?
 Urinary retention is the inability to completely empty the bladder of urine. Chronic urinary
retention, whilst not immediately is not life-threatening

3. How does chronic urinary retention present i.e., what are the symptoms
 Urinary frequency, urgency, and hesitancy
 Poor urinary stream
 Post – micturition dribbling
 Nocturia
 New -onset enuresis
 Urinary incontinence
 Sensation of incomplete voiding after micturition
 Increase lower abdominal discomfort
 Acute urinary retention
 4. Causes:
 Benign prostatic hyperplasia (BPH)
 Prostate carcinoma
 Drugs causing sphincter dysfunction such as antihistamines and anticholinergics
 Congenital deformities
 Urethral strictures due to TB, Gonorrhoea, Trauma

5. Epidemiology:
 Largely affects men: middle aged to older men

6. Symptoms:
 Consistent to UTI and acute urinary retention

7. Signs:
 Check blood pressure
 Abdominal examination – may have palpable enlarged bladder
 Enlargement of kidneys
 Digital rectal examination
 Examine external genitalia to see urethral abnormalities such as strictures, phimosis
 Neurological examination for signs

8. Investigations:
 Urinalysis
 MSU
 Blood tests
 Urinary tract ultrasound
 MRI or CT

International prostate symptom score (IPSS) classifies severity of symptoms.

9. Management:
 Urethral catheterisation
 Consider offering surgery to men who have chronic urinary retention but no impairment of
renal function or upper renal tract abnormality
 General lifestyle: regulate fluid intake, reduce tea/coffee
 Treat BPA with alpha blockers
 Dutasteride and finasteride alternatives to alpha blockers
 Tadalafil