The inability to voluntarily orinate eventhough you have a full bladder and the need to do so. It is the most frequent urological consultation in the emergency services.
It is a consequence of an urethral or bladder-neck obstruction that unables the exit of the urine. The most frequent causes in men are benign prostatic hyperplasia, prostatic cancer and meatal stenosis secondary to surgery. In women, the most frequent causes are uterine prolapse, vesical prolapse and pelvic masses such as myomas or ginecological cancer. With a lesser incidence it can also be a consequence of an infection or inflammation of the urological zone; the most frequent causes are prostatitis and vulvovaginitis. Lastly, there can be a urinary retention when the bladder muscles have not enough strength to contract also known as hypoactive bladder. In this case, the cause is of neurological origin such as that of Parkinson's, Alzheimer's or multiple sclerosis, etc.
Its manifestation is a sudden incapacity to urinate and pain in the lower abdominal area. In some occasions its onset goes alongside inflammation of the lower abdominal region associated to the urinary bladder being full of urine.
The diagnosis is clinical through a questionaire and physical exploration. A culture can be done to discar possible infectious causes and study the renal function as well as imaging tests to monitor vesical fullness or a possible lower urinary tract narrowing. The urologist can perform urodynamic testing to analise the bladder, sphincters and urethral function and also, in order to look at the bladder and urethra's interior, a cytoscope.
Emergency treatment can be performed as a bladder drainage through urinary catheterisation, then, the cause should be treated; if it is caused by prostatic hypertrophy with drugs, if it is because of posturethral surgery scarring with certain procedures to free them, if it is because of a urinary prolapse or tumour, surgery can be performed. In cases that there is a bladder wall weakening, it can be very useful to do exercises to strengthen the pelvic floor as well as a bladder training with scheduled mictions to avoid its filling.
If you suspect you may have acute urinary retention immediately check with your doctor to avoid severe complications.
- Marshall JR, Haber J, Josephson EB. An evidence-based approach to emergency department management of acute urinary retention. Emerg Med Pract 2014; 16:1.
- Manjunath AS, Hofer MD. Urologic Emergencies. Med Clin North Am 2018; 102:373.
- Powell PH, Smith PJ, Feneley RC. The identification of patients at risk from acute retention. Br J Urol 1980; 52:520.
- Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997; 158:481.
- Pickard R, Emberton M, Neal DE. The management of men with acute urinary retention. National Prostatectomy Audit Steering Group. Br J Urol 1998; 81:712.
