Urinary retention

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Background

  • Urologic emergency characterized by sudden inability to pass urine
  • Most common cause is benign prostatic hyperplasia (BPH)
  • Rare in women

Clinical Features

  • Lower abdominal distention / pain
  • Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

Differential Diagnosis

Urinary retention

Evaluation

  • UA/Urine cultures
  • Chemistry
  • CBC (if suspect infection or massive hematuria)
  • Bedside ultrasound (to verify retention)
    • Incomplete retention is PVR > 50ml and > 100ml in patients > 65 years of age[1]
    • Post-void residual of 150-200 cc is particularly concerning

Management

  • Bladder Decompression
    • Urethral catheterization
      • Pass 14-18F Foley catheter (larger if blood clots)
      • If catheterization produces gross blood remove catheter and do not attempt reinsertion
        • Creation of false tract in penile soft tissue requires immediate urology consult
    • Suprapubic catheterization
      • Consider if urethral catheterization fails
      • US-guided results in low complication rate
        • Visualize the needle in the bladder before inserting the catheter
  • Blood clot
    • Use 20-24F triple-lumen catheter to irrigate bladder until clear
  • Voiding trial
  • α-blocker (outpatient) - Tamsulosin 0.4mg qday
    • Results in significant increase in voiding success
    • Possibility of hypotension with med use
  • Bladder spasm
    • Oxybutinin 2.5mg TID
      • Note: Anticholinergic so can cause urinary retention
  • Urology consult
    • Consider for precipitated retention (stricture, prostatitis, cancer)

Disposition

  • Consider admission for:
    • Postobstructive diuresis >200cc/hr
    • Elevated BUN/Cr
    • Clot retention
    • Hematuria
    • Neurologic cause
  • Otherwise consider discharge with catheter and urology follow up in 1 week

See Also

References

  1. Shenot PJ. Urinary Retention. Merck Manual. August 2014. http://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-retention