Acute urinary retention

Revision as of 16:52, 8 December 2018 by Rossdonaldson1 (talk | contribs) (See Also)


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

Clinical Features

  • Suprapubic abdominal distention and/or pain
  • Frequency, urgency, hesitancy, dribbling, decrease in voiding stream

Differential Diagnosis

Urinary retention


  • 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


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[2]
  • If unable to pass Foleyconsider:

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:


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

See Also


  1. Shenot PJ. Urinary Retention. Merck Manual. August 2014.
  2. Management of urinary retention: rapid versus gradual decompression and risk of complications