Urine retention

What is urine retention?

Urine retention is the inability to empty a full bladder. It is the commonest urological emergency worldwide.
Adult males are more commonly affected by this condition. It is rare in children and in females.
The causes differ in different age groups as well as in males and females.

Risk factors for Urine retention

A family history of retention of urine in Benign Prostatic Hyperplasia (BPH), prostate cancer, breast cancer and ovarian cancer are risk factors.

Classification

Urinary retention can be classified into three:

  1. Acute urine retention
  2. Chronic urine retention and
  3. Acute-on-chronic urine retention

1. Acute

This is of sudden onset with a palpable tender bladder.

2. Chronic

This class is of insidious onset and presents with a palpable non-tender bladder and overflow incontinence resulting in more damage to the bladder, ureters and kidneys.
Post-renal renal failure may complicate this type of retention with hydronephroses and hydroureters.

3. Acute-on-chronic

This type is when a chronic retention of urine is suddenly complicated by acute retention of urine.

Causes of Urine retention

  • Adult males – (above 50 years): BPH, urethral strictures, bladder neck stenosis
  • Adult males (below 50 years/young males): urethral strictures, urethral injuries, bladder neck stenosis, neurogenic bladder/spinal injury, paraphimosis, urethral caculi, acute prostatitis
  • Male children – posterior urethral valves, meatal stenosis, phimosis, urethral calculi, congenital strictures
  • Adult females – retroverted gravid uterus, uterine fibroids/myomas, impacted ovarian cysts, neurogenic (postoperative and pelvic inflammatory disease), carcinoma of cervix with infiltration into the urethra

Symptoms of Urine retention

  • Retention of urine in BPH precipitated by postponement of micturition, alcohol abuse and infection
  • Sudden inability to pass urine with painful bulge in lower abdomen for acute retention of urine
  • Gradual onset of inability to pass urine with painless bulge in lower abdomen for chronic retention of urine
  • History of urethritis, urethral instrumentation (e.g. catheterisation) or perineal injury, pelvic fracture or surgery in urethral strictures
  • International Prostate Symptom Score (IPSS)

Signs of Urinary retention

The following are signs of urine retention

  • Palpable tender bladder in acute retention of urine
  • Palpable non-tender bladder for chronic retention of urine
  • Uraemia/Azotaemia in renal failure
  • Fever in infections: UTI and prostatitis Palpable kidneys in hydronephrosis

Treatment for urine retention

Acute case of urine retention can be treated by Catheterization.
This is done under local anesthesia to prevent pain and discomfort during the procedure.
When normal Catheterization is contraindicated, insertion suprapubic catheter into the skin above your bladder to drain the urine may be considered.
Chronic case requires immediate Catheterization to drain the urine.
Not that Catheterization is not to be used for a long period of time because of complications.
If it is imperative that you use catheter for long, then it should be changed frequently to prevent complications.
In both classes, underlying causes should be treated.
Other ways to treat urinary retention include:

  • ¬†Urethral dilation and stents
  • Cystoscope
  • Use of drugs
  • Behaviour modification
  • Surgery

Drugs that can be used to treat urinary retention include antibiotics for infections of the prostate, bladder, or urinary tract, medications to relax your prostate or sphincters and help urine flow more freely and drugs to reduce the size of your prostate if BPH is present.

Referral Criteria

Patients with hydronephroses on ultrasound scan and renal failure should be referred to specialist.