Urinary hesitancy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: hesitancy; delayed urination; difficulty initiating urination

Overview

Urinary hesitancy is defined as difficulty in initiating and maintaining a flow of urine.

Causes

Common Causes

• Anticholinergics
• Benign prostatic hyperplasia
• Prostatic cancer
• Prostatitis
• Shy bladder syndrome
• Tricyclic antidepressants
• Urinary tract infection
• Urinary tract obstruction

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Amitriptyline, Amoxapine, Anticholinergics, Nasal decongestants, Norpramin, Pamelor, Sinequan, Surmontil, Tofranil, Tricyclic antidepressants, Vivactil
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Blood clot in the urethra
Iatrogenic	Recovery from general anesthesia
Infectious Disease	Herpes genitalis, Herpes zoster, Tabes dorsalis, Urinary tract infection, Prostatitis
Musculoskeletal / Ortho	Secondary tumor deposits in vertebra
Neurologic	Multiple sclerosis, Pudendal nerve entrapment, Spinal cord lesions, Syringomyelia, Transverse myelitis, Tabes dorsalis, Tumor of the spinal meninges, Tumor of the spinal cord
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	Retroverted pregnancy, Uterine fibroids, Vaginal carcinoma
Oncologic	Secondary tumor deposits in vertebra, Tumor of the spinal meninges, Urethral carcinoma, Vaginal carcinoma , Prostatic cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	Amitriptyline, Amoxapine, Anticholinergics, Nasal decongestants, Norpramin, Pamelor, Sinequan, Surmontil, Tofranil, Tricyclic antidepressants, Vivactil
Psychiatric	Bashful bladder syndrome, Shy bladder syndrome
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Multiple sclerosis, Transverse myelitis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Bashful bladder syndrome, Benign prostatic hyperplasia, Benign prostatic hypertrophy, Bladder diverticulum, Blood clot in the urethra, Meatal stenosis, Poor bladder contractility, Posterior strictures in males, Primary bladder neck dysfunction, Prostatic cancer, Prostatitis, Shy bladder syndrome, Tight phimosis, Tumor of the spinal cord, Urethral stricture, Urinary tract obstruction, Urinary tract infection, Urethral carcinoma, Reflux nephropathy
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Amitriptyline Amoxapine Anticholinergics Bashful bladder syndrome Benign prostatic hyperplasia Benign prostatic hypertrophy Bladder diverticulum Blood clot in the urethra Diabetes mellitus Herpes genitalis Herpes zoster Meatal stenosis Multiple sclerosis Nasal decongestants Norpramin Pamelor Poor bladder contractility Posterior strictures in males Primary bladder neck dysfunction Prostatic cancer Prostatitis Pudendal nerve entrapment

Recovery from general anesthesia Reflux nephropathy Retroverted pregnancy Secondary tumor deposits in vertebra Shy bladder syndrome Sinequan Spinal cord lesions Surmontil Syringomyelia Tabes dorsalis Tight phimosis Tofranil Transverse myelitis Tricyclic antidepressants Tumor of the spinal cord Tumor of the spinal meninges Urethral carcinoma Urethral stricture Urinary tract infection Urinary tract obstruction Uterine fibroids Vaginal carcinoma Vivactil

Epidemiology and Demographics

Urinary hesitancy is observed in both genders at all ages. It tends to affect elderly males more frequently.

Diagnosis

Laboratory Studies

The following diagnostic studies may be of use:

• Catheterization of the bladder to determine residual urine volume and to get urine for culture (a catheterized urine specimen)
• Cystometrography
• Transrectal ultrasound of the prostate (similar to a transvaginal ultrasound)
• Urethral swab for culture
• Urinalysis and culture
• Voiding cystourethrogram

Treatment

Treatment for urinary hesitancy depends on the cause. Often, medications such as alpha-blockers can relieve the symptoms. If you have a bacterial infection, your health care provider may prescribe antibiotics. You may need surgery to relieve a prostate obstruction (see TURP).