Urinary Retention
last authored: April 2012, David LaPierre
last reviewed:
Introduction
Acute urinary retention can be an extremely uncomfortable condition. It is most often caused by urethral obstruction, nerve damage, or bladder distention.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Factors that predispose for acute urinary retention include:
medical problems
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medications/drugs
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other
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Pathophysiology
Signs and Symptoms
- history
- physical exam
History
History of present illness:
- onset, duration
- trauma
- new medications
- hematuria
- frequency
- urgency
- dysuria
- flank pain
- hesitancy incomplete emptying
- slow or weak stream
- interruption of stream
- dribbling
- constitutional symptoms
Past medical history
- urinary tract infections
- benign prostatic hypertrophy, elevated PSA
- diabetes mellitus
Medications
- especially new medications
- anticholinergics
- opioids
Physical Exam
Vital signs
Abdominal exam
- flank pain
- tender, distended bladder
- DRE
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Bloodwork should include:
- CBC
- electrolytes
- creatinine
- BUN
Urinalysis should include:
- microscopy
- culture and sensitivity
- cytology
Diagnostic Imaging
Ultrasound of bladder and kidneys is an appropriate place to begin.
Post-void residual estimates bladder volume after urination, and may suggest obstruction.
Cystoscopy is warranted if obstruction is likely.
Differential Diagnosis
Treatments
Immediate management is catheterization for a variable time.
Some men may be able to void spontaneously thereafter, though this is more likely if catheter is left in place for a week and if an alpha-adrenergic blockers is given (Emberton and Anson, 1999).
Offending medications, described above, should be avoided.
Consequences and Course
Irinary retention may result in:
- chronic retention
- incontinence
- infection
- hydroneprhosis
- renal failure
Additional Resources
any good free online resources for further reading.
Topic Development
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reviewers:
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