Urinary retention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Synonyms and keywords: Ischuria; urine retention
Overview
Urinary retention is a lack of ability to urinate. It is a common complication of benign prostatic hypertrophy (also known as benign prostatic hyperplasia or BPH), although anticholinergics may also play a role, and requires a catheter. Various medications (e.g. some antidepressants) and recreational use of amphetamines and opiates are notorious for this.
Historical Perspective
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
Classification
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].
Pathophysiology
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Causes
Life Threatening Causes
- Acute renal failure
- Acute respiratory distress syndrome
- Amitriptyline toxicity
- Amoxapine toxicity
- Black widow spider envenomation
- Bladder cancer
- Bladder papilloma
- Brown snake poisoning
- Cardiomyopathy
- Cathinone poisoning
- Chemical poisoning
- Clomipramine toxicity
- Dehydration
- End-stage renal disease
- Gastrointestinal bleeding
- Heat exhaustion
- Hemorrhagic shock
- Jimsonweed poisoning
- Mycobacterium tuberculosis
- Pelvic malignancies
- Prostate cancer
- Pulmonary venous hypertension
- Rhabdomyosarcoma
- Urethral cancer
Common Causes
- Benign prostatic hypertrophy
- Prostate cancer
- Pelvic malignancies
- Congenital urethral valve abnormalities
- Detrusor muscle dyssynergia
- Circumcision
- Damage to the bladder
- Aclidinium bromide
- Benztropine
- Chlorpromazine
- Clobazam
- Cetirizine hydrochloride
- Clemastine
- Cytarabine
- Dexchlorpheniramine
- Ezogabine
- Hydrocodone bitartrate,
- Acetaminophen
- Nabilone
- Nalmefene
- Perphenazine
- Pomalidomide
- Thiothixene
- Thioridazine hydrochloride
- Obstruction in the urethra
- Paruresis
Causes by Organ System
Causes in Alphabetical Order
- Accelerated hypertension
- Aclidinium bromide
- Acquired angioedema
- Acrylamide
- Acute intermittent porphyria
- Acute prostatis
- Acute renal failure
- Acute respiratory distress syndrome
- Ajuga nipponensis makino
- Alcohol
- Aller-chlor
- Al-r
- Amantadine
- Amitriptyline toxicity
- Ammonical ulceration of the foreskin
- Amoxapine toxicity
- Anaesthesia complications
- Anemic
- Antepartum eclampsia
- Anthraquinone
- Antipsychotic agents
- Anuria
- Aortic arches defect
- Apo-clonidine
- Arsine
- Atropine
- Autonomic neuropathy
- Autumn crocus
- Azotemia
- Benign prostatic hypertrophy
- Benztropine
- Black widow spider envenomation
- Bladder cancer
- Bladder conditions
- Bladder diverticulum
- Bladder neck stenosis
- Bladder obstruction
- Bladder papilloma
- Boric acid
- Botulism
- Bright's disease
- Bromaline elixir
- Bromanate elixir
- Bromatapp
- Brown snake poisoning
- Bucladin-s softab
- Buprenex
- Bywaters' syndrome
- C1esterase deficiency
- Cardiomyopathy
- Cast syndrome
- Catapresan-100
- Catastrophic antiphospholipid syndrome
- Cathinone poisoning
- Cauda equina syndrome
- Cetirizine hydrochloride
- Chemical poisoning
- Chlo-amine
- Chlorate salts
- Chloromethane
- Chlorpheniramine
- Chlor-pro
- Chlorpromazine
- Chlor-trimeton
- Chlor-tripolon
- Cholera
- Chromosome 19p duplication syndrome
- Chronic fatigue syndrome
- Chronic granulomatous disease
- Chronic kidney disease
- Cinnarizine
- Circumcision
- Clemastine
- Clobazam
- Clomipramine toxicity
- Clonidine
- Congenital giant megaureter
- Cyclizine
- Cystocele
- Cytarabine
- Cytosar-u
- Damage to the bladder
- Degenerative disc disease
- Dehydration
- Desipramine
- Detrol
- Detrusor muscle dyssynergia
- Dexchlorpheniramine
- Diabetic neuropathy
- Diamorphine
- Diarrhea
- Diphenhydramine
- Dixarit
- Dobriner syndrome
- Donepezil
- Dothiepin
- Doxepin toxicity
- D-plus hemolytic uremic syndrome
- Duodenal atresia
- Durogesic
- Eclampsia
- Edronax
- End-stage renal disease
- Enlarged prostate
- Eosinophilic cystitis
- Epidural anesthetic
- Ethylene glycol
- Eugenol oil poisoning
- Exposure to cold
- Ezogabine
- Familial visceral myopathy
- Fantonest
- Fentanyl injection
- Fesoterodine
- Fowler-christmas-chapple syndrome
- Gastrointestinal bleeding
- Genatap elixir
- General anesthetic
- Glomerulonephritis
- Glyphosate
- Golden chain tree poisoning
- Goodpasture syndrome
- Haematocolpos
- Hair bleach
- Hair dye
- Heat exhaustion
- Hellp syndrome
- Hemolytic uremic syndrome
- Hemorrhagic shock
- Hepatorenal syndrome
- Hereditary angioedema
- Herpes genitalis
- Herpes zoster
- Hydrocodone bitartrate
- Hydronephrosis
- Hydroxyzine
- Hyperemesis gravidarum
- Hypertension of pregnancy
- Hysteria
- Imipramine toxicity
- Impacted calculus in urethra
- Intrapartum eclampsia
- Jimsonweed poisoning
- Kidney stones
- Kloromin
- Lassa fever
- Leptomeningitis
- Levomepromazine
- Lichen sclerosis
- Malignant hypertension
- Marezine
- Maté
- Mayapple poisoning
- Mckusick-kaufman syndrome
- Megacystitis
- Megaduodenum
- Metastatic prostate cancer
- Mouth wash
- Multiple system atrophy
- Munk disease
- Muscarinic antagonists
- Mycobacterium tuberculosis
- Myelitis
- Myphetapp
- Nabilone
- Naked brimcap poisoning
- Nalmefene
- Naropin with fentanyl
- Neisseria gonorrhoea
- Nephritis
- Nephrotic syndrome
- Neurogenic bladder
- Nortriptyline
- Novo-clonidine
- Nu-clonidine
- Obstruction in the urethra
- Ohss
- Ormazine
- Orotic aciduria
- Orotidylic decarboxylase deficiency
- Oxalosis
- Paruresis
- Pdeunculated bladder tumor
- Pelvic malignancies
- Perazine
- Perirectal abscess
- Perphenazine
- Pethidine
- Phenelzine
- Phenetron
- Phyllodes tumor
- Pipothiazine
- Pizotifen
- Plant poisoning
- Poliomyelitis
- Polyarteritis nodosa
- Polycystic ovaries urethral sphincter dysfunction
- Pomalidomide
- Posterior urethral valve
- Posterior valve
- Postoperative spindle cell nodule
- Postpartum eclampsia
- Post-vaccinial encephalitis
- Pregnancy
- Prochlorperazine
- Prolapse of invertebral disc
- Prostate cancer
- Prostate conditions
- Prostate enlargement
- Prostate hyperplasia
- Prostatic abscess
- Prostatic enlargement
- Prostatic stromal proliferations of uncertain malignant potential
- Protriptyline toxicity
- Prune belly syndrome
- Pudendal nerve entrapment
- Pulmonary branches stenosis
- Pulmonary venous hypertension
- Radiotherapy
- Reboxetine
- Rectal operations
- Rénon-delille syndrome
- Retigabine
- Retroperitoneal fibrosis
- Rhabdomyosarcoma
- Sea snake poisoning
- Senna
- Septic abortion
- Shock
- Solanum tuberosum
- Solder
- Spirochetes disease
- Sublimaze
- Surgery complication
- Tamine
- Telachlor
- Teldrin
- Temegesic
- Terodiline
- Tetanus
- Thioridazine hydrochloride
- Thiothixene
- Thorazine
- Tolterodine
- Toxic mushrooms
- Transthyretin amyloidosis
- Transverse myelitis
- Trimipramine toxicity
- Ureter obstruction
- Urethral cancer
- Urethral catheterization
- Urethral injury
- Urethral obstruction
- Urethral stricture
- Urinary catheters
- Urinary foreign bodies
- Urinary outflow obstruction
- Urinary scar tissue
- Urinary stones
- Urinary strictures
- Urinary tract infections
- Urinary tumors
- Uterine prolapse
- Variegate porphyria
- Vibazine
- Vibrio infection
- Waterhouse-friederichsen syndrome
- Weil syndrome
- Yellow fever
Differentiating ((Page name)) from other Diseases
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Epidemiology and Demographics
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
OR
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
OR
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
Patients of all age groups may develop [disease name].
OR
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
OR
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
OR
[Chronic disease name] is usually first diagnosed among [age group].
OR
[Acute disease name] commonly affects [age group].
There is no racial predilection to [disease name].
OR
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
[Disease name] affects men and women equally.
OR
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
The majority of [disease name] cases are reported in [geographical region].
OR
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Risk Factors
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications and Prognosis
In the longer term, obstruction of the urinary tract may cause:
- Bladder stones
- Loss of detrusor muscle tone (atonic bladder is an extreme form)
- Hydronephrosis (congestion of the kidneys)
- Hypertrophy of detrusor muscle
- Diverticula in the bladder wall (leads to stones and infection)
Diagnosis
History and Symptoms
Urinary retention is characterised by poor urinary stream with intermittance, straining, a sense of incomplete voiding and urgency. As the bladder remains full, it may lead to incontinence, nocturia (need to urinate at night) and high frequency. Retention is a medical emergency, as the bladder may distend (stretch) to enormous sizes and possibly tear if not dealt with quickly. If the bladder distends enough it will begin to become painful. The water can also pass back up the ureters and get into the kidneys, causing kidney failure. You should go straight to your emergency department as soon as possible if you are unable to urinate and you have a painfully full bladder.
Laboratory Findings
Urea and creatinine determinations may be necessary to rule out backflow kidney damage.
Other Imaging Findings
Uroflowmetry may aid in establishing the type of micturition abnormality. A post-void residual scan may show the amount of urine retained. Determination of the serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate cancer.
Treatment
Medical Therapy
In acute urinary retention, urinary catheterization or suprapubic cystostomy instantly relieves the retention. In the longer term, treatment depends on the cause. Benign prostatic hypertrophy may respond to alpha blocker and 5-alpha-reductase inhibitor therapy, or surgically with prostatectomy or transurethral resection of the prostate (TURP).
Urinary retention is considered an absolute contraindication to the use of the following medications:
Surgery
One study describes five men who suffered acute urinary retention and who were all advised by their urologists that they must undergo surgery (transurethral resection of the prostate, TURP). Instead all five men were treated with catheter removal followed by repetitive prostatic massage, extensive microbial diagnosis, and antibiotics, as well as alpha-blockers, and in two cases finasteride. During treatment, statistically significant improvements occurred in global symptom severity scores, urethral white blood cell (WBC) counts, WBC counts of the expressed prostatic secretions (EPS), EPS red blood cell (RBC) counts, urinary WBC counts, and urinary RBC counts. The treatment enabled catheter removal in all 5 men (100%) as well as successful urination in all 5 men (100%). Surgery was able to be postponed indefinitely in all five men.[1]
Related Chapters
References
- ↑ Hennenfent BR, Lazarte AR, Feliciano AE. Repetitive prostatic massage and drug therapy as an alternative to transurethral resection of the prostate. MedGenMed. 2006 Oct 25;8(4):19. PMID: 17415302.