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

Common Causes

Causes by Organ System

Cardiovascular Accelerated hypertension  , Antepartum eclampsia  , Aortic arches defect  , Cardiomyopathy, Cast syndrome  , Hellp syndrome  , Hypertension of pregnancy  , Malignant hypertension  , Pulmonary branches stenosis, Pulmonary venous hypertension 
Chemical/Poisoning Aclidinium bromide, Acrylamide  , Ajuga nipponensis makino, Alcohol, Arsine  , Autumn crocus  , Black widow spider envenomation  , Boric acid  , Brown snake poisoning  , Cathinone poisoning  , Cetirizine hydrochloride, Chemical poisoning , Chlo-amine, Chlorate salts  , Chloromethane  , Chlorpheniramine, Chlor-pro, Chlorpromazine, Chlor-trimeton, Chlor-tripolon, Doxepin toxicity  , Ethylene glycol  , Eugenol oil poisoning  , Golden chain tree poisoning  , Hair bleach  , Hair dye  , Jimsonweed poisoning  , Mayapple poisoning  , Muscarinic antagonists, Naked brimcap poisoning  , Orotidylic decarboxylase deficiency  , Plant poisoning, Protriptyline toxicity  , Sea snake poisoning  , Senna  , Solanum tuberosum, Solder, Sublimaze, Toxic mushrooms
Dental No underlying causes
Dermatologic Dobriner syndrome 
Drug Side Effect Aller-chlor, Al-r, Amantadine, Anthraquinone  , Antipsychotic agents, Apo-clonidine, Atropine, Benztropine, Bromaline elixir, Bromanate elixir, Bromatapp, Bucladin-s softab, Buprenex, Catapresan-100, Cinnarizine, Clemastine, Clobazam, Clomipramine toxicity  , Clonidine, Cyclizine, Cystocele  , Cytarabine, Cytosar-u, Desipramine, Detrol, Dexchlorpheniramine, Diamorphine, Diphenhydramine, Dixarit, Donepezil, Dothiepin, Edronax, Ezogabine, Fantonest, Fentanyl injection, Fesoterodine, Genatap elixir, General anesthetic, Glyphosate  , Hydrocodone bitartrate , Hydroxyzine, Imipramine toxicity  , Kloromin, Levomepromazine, Mouth wash, Muscarinic antagonists, Myphetapp, Nabilone, Nalmefene, Naropin with fentanyl, Nortriptyline, Novo-clonidine, Nu-clonidine, Ormazine, Perazine, Perphenazine, Pethidine, Phenelzine, Phenetron, Pipothiazine, Pizotifen, Pomalidomide, Prochlorperazine, Reboxetine, Retigabine, Tamine, Telachlor, Teldrin, Temegesic, Terodiline, Thioridazine hydrochloride, Thiothixene, Thorazine, Tolterodine, Vibazine
Ear Nose Throat No underlying causes
Endocrine Acute intermittent porphyria  , Duodenal atresia  , Durogesic, Rénon-delille syndrome
Environmental Exposure to cold
Gastroenterologic Acute intermittent porphyria  , Diarrhea  , Duodenal atresia  , Durogesic, Gastrointestinal bleeding  , Hepatorenal syndrome  , Megaduodenum, Perirectal abscess  , Prune belly syndrome  , Rectal operations
Genetic Chromosome 19p duplication syndrome  , Congenital giant megaureter, Eosinophilic cystitis  , Fowler-christmas-chapple syndrome  , Mckusick-kaufman syndrome  , Munk disease  , Transthyretin amyloidosis  , Variegate porphyria  , Waterhouse-friederichsen syndrome  , Weil syndrome 
Hematologic Acute intermittent porphyria  , Anemic , Chronic granulomatous disease  , D-plus hemolytic uremic syndrome , Gastrointestinal bleeding  , Haematocolpos, Hemolytic uremic syndrome  , Hemorrhagic shock, Postoperative spindle cell nodule
Iatrogenic Anaesthesia complications  , Epidural anesthetic, General anesthetic, Post-vaccinial encephalitis  , Radiotherapy, Rectal operations, Surgery complication, Urinary catheters
Infectious Disease Botulism, Cholera  , Herpes genitalis, Herpes zoster, Lassa fever, Leptomeningitis, Lichen sclerosis  , Marezine, Mycobacterium tuberculosis, Neisseria gonorrhoea, Nephritis  , Perirectal abscess  , Poliomyelitis, Prostatic abscess  , Spirochetes disease  , Tetanus  , Vibrio infection , Weil syndrome  , Yellow fever 
Musculoskeletal/Orthopedic Degenerative disc disease  , Detrusor muscle dyssynergia, Familial visceral myopathy  , Pelvic malignancies, Prolapse of invertebral disc, Prune belly syndrome  , Rhabdomyosarcoma, Tetanus 
Neurologic Autonomic neuropathy  , Cauda equina syndrome  , Chronic fatigue syndrome  , Diabetic neuropathy  , Intrapartum eclampsia  , Leptomeningitis, Multiple system atrophy  , Myelitis  , Neurogenic bladder, Poliomyelitis, Post-vaccinial encephalitis  , Pudendal nerve entrapment  , Transverse myelitis
Nutritional/Metabolic Dehydration  , Diabetic neuropathy  , Diarrhea  , Maté  , Oxalosis
Obstetric/Gynecologic Antepartum eclampsia  , Eclampsia  , Epidural anesthetic, Haematocolpos, Hellp syndrome  , Hyperemesis gravidarum  , Hypertension of pregnancy  , Intrapartum eclampsia  , Ohss  , Polycystic ovaries urethral sphincter dysfunction, Postpartum eclampsia  , Pregnancy, Rénon-delille syndrome , Septic abortion  , Uterine prolapse 
Oncologic Bladder cancer  , Metastatic prostate cancer, Pdeunculated bladder tumor, Pelvic malignancies, Phyllodes tumor , Postoperative spindle cell nodule , Prostate cancer, Rhabdomyosarcoma, Urethral cancer  , Urinary tumors
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol, Amitriptyline toxicity, Amoxapine toxicity  , Clomipramine toxicity  , Doxepin toxicity  , Fentanyl injection, Toxic mushrooms , Trimipramine toxicity 
Psychiatric Hysteria, Paruresis
Pulmonary Acute respiratory distress syndrome, Mycobacterium tuberculosis, Pulmonary branches stenosis, Pulmonary venous hypertension 
Renal/Electrolyte Acute renal failure  , Azotemia, Bright's disease, Bywaters' syndrome  , Chronic kidney disease  , Dehydration  , End-stage renal disease  , Eosinophilic cystitis  , Glomerulonephritis  , Goodpasture syndrome  , Hydronephrosis  , Impacted calculus in urethra, Kidney stones  , Nephritis  , Nephrotic syndrome  , Orotic aciduria    , Oxalosis, Retroperitoneal fibrosis
Rheumatology/Immunology/Allergy Acquired angioedema  , C1esterase deficiency, Cardiomyopathy, Catastrophic antiphospholipid syndrome  , Dobriner syndrome  , Goodpasture syndrome  , Hereditary angioedema, Polyarteritis nodosa 
Sexual Herpes genitalis
Trauma Cauda equina syndrome  , Damage to the bladder, Exposure to cold, Heat exhaustion  , Prolapse of invertebral disc, Shock, Urethral injury
Urologic Acute prostatis , Ammonical ulceration of the foreskin , Anuria  , Benign prostatic hypertrophy, Bladder cancer  , Bladder conditions, Bladder diverticulum  , Bladder neck stenosis, Bladder obstruction, Bladder papilloma  , Circumcision, Damage to the bladder, D-plus hemolytic uremic syndrome , Enlarged prostate, Hemolytic uremic syndrome  , Impacted calculus in urethra, Megacystitis , Metastatic prostate cancer, Neurogenic bladder, Obstruction in the urethra, Orotic aciduria    , Paruresis, Pdeunculated bladder tumor, Polycystic ovaries urethral sphincter dysfunction, Posterior urethral valve, Posterior valve, Prostate cancer, Prostate conditions, Prostate enlargement, Prostate hyperplasia, Prostatic abscess  , Prostatic enlargement, Retroperitoneal fibrosis, 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
Miscellaneous Urethral obstruction

Causes in Alphabetical Order

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 of urinary retention to 6.8/1,000 men, Age 40 to 83.
  • The incidence of acute urinary retention is 300 /1000 men, Age 80s.
  • Urinary retention in women though not rare but is very uncommon.
  • The incidence of urinary retention increases with age.
  • It commonly effects people older than 50 years of age.
  • Mostly has as acute presentation, but chronic forms also exit.
  • There is racial predilection to African Men.
  • Caucasians are less like to develop acute urine retention because of low risk of prostate cancer and benign prostatic hyperplasia.


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:

Diagnosis

Diagnostic Study of Choice

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

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.

Physical Examination

  • Patients with urinary retention generally appear in acute distress.
  • Common physical examination findings of the disease include unable to void, lower abdominal pain, back pain, and acute distress if the bladder is full.
  • The presence of full bladder found by dull percussion and bladder palpation of lower abdomen is highly suggestive of the disease.
  • If enlarge prostate is the cause of obstruction it can be noted on digital rectal exam after patient is stabilized.


Laboratory Findings

Urea and creatinine determinations may be necessary to rule out backflow kidney damage.

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


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.

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

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]

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

Related Chapters

References

  1. ↑ 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.

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