Urinary Retention in Adults: Evaluation and Initial Management

Area of Science:

• Urology
• Nephrology

Background:

• Urinary retention is the inability to voluntarily void urine, affecting men more frequently.
• Obstructive causes, particularly benign prostatic hyperplasia (BPH), account for the majority of cases.
• Infectious, inflammatory, iatrogenic, and neurologic factors can also precipitate urinary retention.

Purpose of the Study:

• To outline the evaluation and management of acute and chronic urinary retention.
• To define diagnostic criteria and therapeutic strategies for urinary retention.

Main Methods:

• Initial assessment includes detailed medical history, medication review, and physical examination with neurologic evaluation.
• Diagnostic testing focuses on measuring postvoid residual (PVR) urine volume.
• The American Urological Association suggests defining chronic urinary retention as PVR > 300 mL on two occasions over six months.

Main Results:

• Prompt bladder decompression via catheterization is the initial management step.
• Suprapubic catheterization offers short-term benefits in patient comfort and reduced bacteriuria.
• Alpha-blockers and voiding trials are part of subsequent management, tailored to the cause and chronicity.

Conclusions:

• Management hinges on identifying the cause and duration of urinary retention.
• Neurologically-related cases require multidisciplinary monitoring by neurology and urology specialists.
• Further treatment strategies are guided by the underlying etiology and patient-specific factors.