Etiology and management of urinary retention in women

Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a "psychogenic basis" should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler's syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.