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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Causes|Causes]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Urinary retention in women|Urinary retention in women]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Urinary Retention in Women|Urinary retention in women]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Urinary Retention in Men|Urinary Retention in Men]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary retention resident survival guide#Urinary Retention in Men|Urinary Retention in Men]]
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{{SK}}
{{SK}}
==Overview==
==Overview==
[[Urinary retention]] can be 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]] which 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, brings the patient immediately in attention, 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]] 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.


==Causes==
==Causes==
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===Urinary Retention in Men===
===Urinary Retention in Men===
Urinary retention is much more common in males with male to female ratio being 13:1.
Urinary retention is more common in males, with a male to female ratio of 13:1.


'''Causes of Acute urinary retention in men'''<br>
'''Causes of Acute urinary retention in men'''<br>
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❑ [[Inquire about lower urinary symptoms|<span style="color:white;">inquire about lower urinary symptoms</span>]]  
❑ [[Inquire about lower urinary symptoms|<span style="color:white;">inquire about lower urinary symptoms</span>]]  
:❑ [[how often patient has this difficulty in voiding|<span style="color:white;">how often patient has this difficulty in voiding</span>]]
:❑ [[how often patient has this difficulty in voiding|<span style="color:white;">how often patient has this difficulty in voiding</span>]]
:❑ [[how frequently patient void in a single day|<span style="color:white;">how frequently patient void in a single day</span>]]
:❑ [[how frequently patient voids in a single day|<span style="color:white;">how frequently patient void in a single day</span>]]
:❑ [[how frequently patient has weak stream of urine|<span style="color:white;">how frequently patient has weak stream of urine</span>]]
:❑ [[how frequently patient has a weak stream of urine|<span style="color:white;">how frequently patient has weak stream of urine</span>]]
:❑ [[ask patient about difficulty holding urine|<span style="color:white;">ask patient about difficulty holding urine</span>]]  
:❑ [[ask patient about difficulty holding urine|<span style="color:white;">ask patient about difficulty holding urine</span>]]  
:❑ [[ask about nocturia|<span style="color:white;">ask about nocturia</span>]]
:❑ [[ask about nocturia|<span style="color:white;">ask about nocturia</span>]]
:❑ [[Does the patient have to strain or push to urinate|<span style="color:white;">Does the patient have to strain or push to urinate</span>]]
:❑ [[Does the patient have to strain or push to urinate|<span style="color:white;">Does the patient have to strain or push to urinate</span>]]
:❑ [[ask about dribling after passing urine|<span style="color:white;">ask about dribling after passing urine</span>]]<br>
:❑ [[ask about dribbling after passing urine|<span style="color:white;">ask about dribling after passing urine</span>]]<br>
❑ [[inquire about past history of prostate disease or cancer|<span style="color:white;">Inquire about past history of prostate disease or cancer</span>]] <br>
❑ [[inquire about past history of prostate disease or cancer|<span style="color:white;">Inquire about past history of prostate disease or cancer</span>]] <br>
❑ [[Inquire about history of stones, STIs, radiation exposure|<span style="color:white;">Inquire about history of stones, STIs, radiation exposure</span>]] <br>
❑ [[Inquire about history of stones, STIs, radiation exposure|<span style="color:white;">Inquire about history of stones, STIs, radiation exposure</span>]] <br>
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{{familytree | | | | | C01 |-|-|'| | | | | C01=<div style="text-align: left; background: #FA8072; padding:1em;">{{fontcolor|#F8F8FF|If recurrent urinary retention-repeat alpha blocker and TwoC|<span style="color:white;">urinary retention</span>]] repeat alpha blocker and TwoC|<span style="color:white;">TwoC</span>]]}}</div>}}
{{familytree | | | | | C01 |-|-|'| | | | | C01=<div style="text-align: left; background: #FA8072; padding:1em;">{{fontcolor|#F8F8FF|If recurrent urinary retention-repeat alpha blocker and TwoC|<span style="color:white;">urinary retention</span>]] repeat alpha blocker and TwoC|<span style="color:white;">TwoC</span>]]}}</div>}}
{{Family tree/end}}
{{Family tree/end}}




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{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | | | | | A01 |A01=POSTOPERATIVE URINARY RETENTION<ref name="pmid31751034">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=31751034 | doi= | pmc= | url= }} </ref>}}  
{{familytree | | | | | | | | | | | | | A01 | | | | | | | |A01=POSTOPERATIVE URINARY RETENTION}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| }}
{{familytree | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| }}
{{familytree | | | | | B01 | | | | | | | | | | | | | | B02| | |B01=[[Prevention]] |B02=[[Treatment]]}}
{{familytree | | | | | B01 | | | | | | | | | | | | | | B02| | |B01=[[Prevention]] |B02=[[Treatment]]}}
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*Keep a close eye on the patient for [[dehydration]] and [[Metabolic disorders|metabolic abnormalities]] which may result from [[post obstructive diuresis]].
*Keep a close eye on the patient for [[dehydration]] and [[Metabolic disorders|metabolic abnormalities]] which may result from [[post obstructive diuresis]].
*Perform [[Catheterization|suprapubic catheterization]] in [[patients]] who had recent surgery and it should be [[ultrasound-guided]].
*Perform [[Catheterization|suprapubic catheterization]] in [[patients]] who had recent surgery and it should be [[ultrasound-guided]].
*Do admit the [[patient]] with [[Urinary Tract Infections|urosepsis]], [[renal failure]], [[electrolyte imbalance]], [[malignancy]], or [[myelopathy|acute myelopathy]].
*Admit the [[patient]] with [[Urinary Tract Infections|urosepsis]], [[renal failure]], [[electrolyte imbalance]], [[malignancy]], or [[myelopathy|acute myelopathy]].
*It is must to educate the patient about [[Catheter|catheter care]] and [[Urine output|urine output monitoring]].<ref name="pmid30860732">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30860732 | doi= | pmc= | url= }} </ref> <ref name="pmid30860734">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30860734 | doi= | pmc= | url= }} </ref>
*It is must to educate the patient about [[Catheter|catheter care]] and [[Urine output|urine output monitoring]].


==Don'ts==
==Don'ts==


*Do not perform [[urethral catheterization]] if the patient had a recent urologic surgery such as [[radical prostatectomy]] or [[urethral reconstruction]].
*Do not perform [[urethral catheterization]] if the patient had a recent urologic surgery such as [[radical prostatectomy]] or [[urethral reconstruction]].
*Do not start [[antibiotics]] until and unless the [[infection]] is confirmed.
*Do not start [[antibiotics]] until an [[infection]] is confirmed.
*Catheterization in Men with [[BPH]] should not be more than 7 days. <ref name="pmid30860734">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30860734 | doi= | pmc= | url= }} </ref>
 


==References==
==References==
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[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
[[Category:Needs english review]]
[[Category:Up-To-Date]]
[[Category:Urology]]
[[Category:Urology]]

Latest revision as of 13:24, 15 April 2021


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

Urinary retention Resident Survival Guide Microchapters
Overview
Causes
Urinary retention in women
Urinary Retention in Men
Diagnosis
Treatment
Do's
Don'ts

Synonyms and keywords:

Overview

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.

Causes

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
Constipation
Urolithiasis
Urethral Stricture
Phimosis or Paraphimosis

❑ Infectious Causes

Prostatitis
Urethritis
Genital herpes

❑ Neurological Causes

stroke
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
Antidepressants-Amitriptyline,Imipramine
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
Antihypertensives-Hydralazine,nifedipine
❑ Others-indomethacin, morphine, dopamine, amphetamines

Causes of Chronic urinary retention in Men
❑ Neurological Causes

Diabetic neuropathy
peripheral neuropathy
Spinal injury

Detrusor Muscle Dysfunction

Diagnosis

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?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
>300ml
 
<200 ml
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ suggest urinary retention-keep catheter in place if >400 ml
 
Urinary retention unlikely
 

Treatment

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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
successful
 
failed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Successful
 
failed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 



 
 
 
 
 
 
 
 
 
 
 
 
POSTOPERATIVE URINARY RETENTION
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prevention
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Preoperative
 
Intraoperative
 
Postoperative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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

Do's

Don'ts


References

  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.