View source for Acute urinary retention

==Background==
[[File:Urinary system.png|thumb|'''(1) Human urinary system:''' (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra. <Br>'''Additional structures:''' (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.]]
[[File:2605 The Bladder.jpg|thumb|Anatomy of the male bladder, showing transitional epithelium and part of the wall in a histological cut-out.]]
*Urologic emergency characterized by sudden inability to pass urine
*Most common cause is [[benign prostatic hyperplasia]] (BPH)
*Rare in women

==Clinical Features==
[[File:Urinary retention.jpg|thumb|Patient with acute urinary retention and dramatic bladder distention.]]
*Suprapubic abdominal distention and/or pain
*Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

==Differential Diagnosis==
{{Urinary retention DDX}}
{{DDX abdominal distention}}

==Evaluation==
[[File:Ultrasound of trabeculated urinary bladder.jpg|thumb|Ultrasound of distended from urinary retention. Note trabeculated wall, which is a sign of urinary retention.]]
[[File:Harnverhalt.jpg|thumb|Bladder distension from acute urinary retention seen on CT.]]
*[[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<ref>Shenot PJ. Urinary Retention. Merck Manual. August 2014. http://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-retention</ref>
**Post-void residual of 150-200 cc is particularly concerning

==Management==
===Bladder Decompression===
*Urethral catheterization
**Pass 14-18F Foley catheter (larger if blood clots)
**Rate of decompression: rapid complete drainage 
***At one time, rapid complete bladder decompression was thought to increase the rate of potential complications, however partial drainage and clamping does not reduce these complications and may increase risk for [[UTI]]<ref>Management of urinary retention: rapid versus gradual decompression and risk of complications</ref>
*If unable to pass Foley, consider:
**[[Coude catheter]]
**[[Suprapubic catheterization]]

===Other Considerations===
*Blood clot
**Use 20-24F triple-lumen catheter to irrigate bladder until clear
*Consider α-blocker as outpatient if concern for BPH (e.g. [[tamsulosin]] 0.4mg QHS)
**Results in significant increase in voiding success
**Possibility of orthostatic hypotension 
*Urology consult
**Consider for precipitated retention (e.g. stricture, prostatitis, cancer) or need for [[suprapubic catheterization]]

==Disposition==
===Admission===
Admit for:
*[[Post-obstructive diuresis]] >200mL/hr for 2 hours or 3L over 24 hours (will need fluids and electrolyte monitoring/repletion)
*Elevated BUN/Cr ([[acute renal failure]])
*Significant [[hematuria]] or clot retention
*New neurologic cause (e.g. [[cord compression]])

===Discharge===
*Otherwise consider discharge with catheter placed to leg bag and urology follow up within 1 week

==See Also==
*[[Coude catheter]]
*[[Suprapubic catheter placement]]
*[[Suprapubic bladder aspiration]]
*[[Suprapubic catheter changing or replacement]]
*[[Post-obstructive diuresis]]

[[Category:Urology]]

==References==
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