Acute urinary retention in children

Acute urinary retention is relatively infrequent in children. There are a variety of causes that are poorly defined in the literature, and they differ greatly from those seen most frequently in adults. We review our experience with pediatric patients presenting with urinary retention to 2 major metropolitan children's hospitals.

Records from Egleston and Scottish Rite Hospitals for Children were reviewed for a 6-year period for the diagnosis of urinary retention. Urinary retention was defined as inability to empty the bladder volitionally for greater than 12 hours with a volume of urine greater than expected for age ([age in years + 2] x 30 cc) or a palpably distended bladder. All cases resulting postoperatively and believed secondary to surgical dissection, narcotic use or immobility, and children previously diagnosed with chronic neurological disorders and voiding dysfunction or with reduced mental status were excluded from study. The majority of these encounters were emergency department visits specifically for acute urinary retention.

We identified 53 children meeting these criteria, including 37 boys 6 months to 17 years old and 16 girls 1 to 17 years old. Etiologies included neurological processes in 17%, severe voiding dysfunction in 15%, urinary tract infection in 13%, constipation in 13%, adverse drug effect in 13%, local inflammatory causes in 7%, locally invading neoplasms in 6%, benign obstructing lesions in 6%, idiopathic in 6%, combined urinary tract infection and constipation in 2%, and incarcerated inguinal hernia in 2% of cases. Adverse drug effects and dysfunctional voiding were implicated 3 times as often in males than females (16% versus 6% and 19% versus 6%, respectively). Urinary tract infections were 6 times more common in females (31% versus 5%). Constipation and local inflammatory processes were twice as common in females than males (19% versus 11% and 12% versus 5%, respectively). Local neoplasms, benign obstruction and idiopathic causes were found exclusively in males.

Urinary retention in children is a relatively rare entity but there is a significant incidence of neurological abnormalities in this population. If a clear reason for this condition cannot be delineated based on history, physical examination and laboratory assessment, these patients should undergo prompt neurological evaluation and appropriate imaging studies.