Management of acute urinary retention

Area of Science:

• Urology
• Emergency Medicine

Background:

• Acute urinary retention (AUR) is a prevalent urological emergency causing sudden, painful inability to urinate.
• Management of AUR varies significantly due to differing healthcare access and lack of standardized protocols.
• Traditional secondary management often involved prompt prostatic surgery, carrying substantial risks.

Purpose of the Study:

• To review current management strategies for acute urinary retention.
• To evaluate the efficacy and safety of conservative approaches versus immediate surgical intervention.
• To identify predictors of successful conservative management and long-term outcomes.

Main Methods:

• Review of immediate treatment options, including urethral and suprapubic catheterization.
• Analysis of the shift towards conservative management, specifically the "trial without catheter" approach.
• Investigation into the role of alpha1-adrenergic blockers and predictive factors for treatment success.

Main Results:

• A trial without catheter (TWOC) after initial bladder decompression is increasingly used, with spontaneous voiding achieved in 23-40% of cases.
• Alpha1-adrenergic blockers enhance the success rate of TWOC.
• Elevated prostate-specific antigen, postvoid residual volume, and response to alfuzosin may predict outcomes in conservatively managed AUR patients.

Conclusions:

• The management of AUR is transitioning towards less invasive strategies, prioritizing patient safety and reducing surgical morbidity.
• The trial without catheter, often combined with alpha-blocker therapy, offers a viable alternative to immediate surgery.
• Further research into predictive markers can optimize patient selection for conservative management of acute urinary retention.