Urinary Retention

a, b
Michael Billet, MD *, Thomas Andrew Windsor, MD

KEYWORDS
 Retention  Urinary retention  Catheter  Catheterization  Foley
 Benign prostatic hyperplasia

KEY POINTS
 Urinary retention is caused by obstructive, infectious, pharmacologic/iatrogenic, and
neurogenic processes. Obstructive retention due to benign prostatic hyperplasia (BPH)
is the most common single cause.
 Bladder decompression is the mainstay of treatment of acute retention; with few excep-
tions, laboratory workup and imaging should not delay decompression.
 Laboratory workup for acute retention should include urinalysis to exclude infection. Renal
function and electrolytes should be obtained in severe or prolonged retention, or with
postobstructive diuresis.
 Patients who are hemodynamically stable, have normal postdecompression urine output
and renal function, and are capable of maintaining their catheters can be discharged with
outpatient follow-up.

INTRODUCTION

Urinary retention is a common problem encountered in the emergency department.

Acute urinary retention (AUR) presents as a sudden inability to voluntarily void, and
is typically associated with lower abdominal pain. Although the most common cause
is prostatic enlargement, particularly benign prostatic hyperplasia (BPH), its etiology
can be varied and multifactorial.1 Treatment of all types of retention aims to decom-
press the bladder and mitigate the underlying cause of retention. This can generally
be accomplished in the emergency department without immediate urologic consulta-
tion; however, certain clinical features may require specialist involvement in the emer-
gency department or outpatient setting. This article provides an overview of the
common causes of AUR, as well as emergency department evaluation, treatment,
and disposition of AUR in men and women.

Disclosure Statement: The authors have nothing to disclose.

a
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore,
MD, USA; b Department of Emergency Medicine, University of Maryland School of Medicine,
110 South Paca Street - Suite 200, Baltimore, MD 21201, USA
* Corresponding author. 110 South Paca Street, Suite 200, Baltimore, MD 21201, USA.
E-mail address: mbillet@som.umaryland.edu

Emerg Med Clin N Am 37 (2019) 649–660

https://doi.org/10.1016/j.emc.2019.07.005 emed.theclinics.com
0733-8627/19/ª 2019 Elsevier Inc. All rights reserved.