Urinary Retention in Adults: Evaluation and Initial Management

 

Am Fam Physician. 2018 Oct 15;98(8):496-503.

Author disclosure: Dr. Stoffel reports receiving grant funding from Ipsen and Cogentix in relation to treatment of neurogenic overactive bladder and stress incontinence; the other authors have no relevant financial affiliations.

Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine. The condition predominantly affects men. The most common causes are obstructive in nature, with benign prostatic hyperplasia accounting for 53% of cases. Infectious, inflammatory, iatrogenic, and neurologic causes can also affect urinary retention. Initial evaluation should involve a detailed history that includes information about current prescription medications and use of over-the-counter medications and herbal supplements. A focused physical examination with neurologic evaluation should be performed, and diagnostic testing should include measurement of postvoid residual (PVR) volume of urine. There is no consensus regarding a PVR-based definition for acute urinary retention; the American Urological Association recommends that chronic urinary retention be defined as PVR volume greater than 300 mL measured on two separate occasions and persisting for at least six months. Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization. Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term; silver alloy–coated and antibiotic-impregnated catheters offer clinically insignificant or no benefit. Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials. Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists.

Urinary retention is the inability to voluntarily pass an adequate amount of urine and can be attributable to acute and chronic etiologies. Acute urinary retention is a urologic emergency characterized by the sudden inability to urinate combined with suprapubic pain, bloating, urgency, distress, or, occasionally, mild incontinence.1 Chronic urinary retention is usually associated with non-neurogenic causes, is often asymptomatic, and lacks consensus on defining criteria. The overall incidence of urinary retention is much higher in men than women and increases dramatically as men age. Estimates for men range from 4.5 to 6.8 per 1,000 person-years, increasing up to 300 per 1,000 person-years for men in their 80s, whereas the incidence in women is only seven per 100,000 per year.24

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Initial evaluation of the patient with suspected urinary retention should involve a detailed history, including current use of prescription and over-the-counter medications and herbal supplements.

C

5

A focused physical examination, including a neurologic evaluation, should be performed in patients with suspected urinary retention, and diagnostic testing should include measurement of postvoid residual urine volume.

C

5

Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in patients requiring catheterization for up to 14 days.

A

29

Silver alloy–coated and antibiotic-impregnated urethral catheters are not recommended for use in patients with suspected urinary retention because neither produces significantly positive results.

A

31

In patients with urinary retention, initiation of alpha-blocker therapy at the time of catheter insertion or at least before removal is suggested because alpha blockers improve the likelihood of a successful voiding trial.

A

3537


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Initial evaluation of the patient with suspected urinary retention should involve a detailed history, including current use of prescription and over-the-counter medications and herbal supplements.

C

5

A focused physical examination, including a neurologic evaluation, should be performed in patients with suspected urinary retention, and diagnostic testing should include measurement of postvoid residual urine volume.

C

5

Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in patients requiring catheterization for up to 14 days.

A

29

Silver alloy–coated and antibiotic-impregnated urethral catheters are not recommended for use in patients with suspected urinary retention because neither produces significantly positive results.

A

31

In patients with urinary retention, initiation of alpha-blocker therapy at the time of catheter insertion or at least before removal is suggested because alpha

The Authors

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DAVID C. SERLIN, MD, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor....

JOEL J. HEIDELBAUGH, MD, is a clinical professor in the Departments of Family Medicine and Urology at the University of Michigan Medical School.

JOHN T. STOFFEL, MD, is a professor in the Department of Urology at the University of Michigan Medical School.

Address correspondence to David C. Serlin, MD, Department of Family Medicine, University of Michigan Medical School, 300 North Ingalls St., NI4C06, Ann Arbor, MI 48109-5435. Reprints are not available from the authors.

Author disclosure: Dr. Stoffel reports receiving grant funding from Ipsen and Cogentix in relation to treatment of neurogenic overactive bladder and stress incontinence; the other authors have no relevant financial affiliations.

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