Management of acute urinary retention in the emergency department

Etiologies of acute urinary retention fall into 4 broad categories: structural, medication/ toxicologic, neurologic, and infectious. Although two-thirds of cases in men are related to prostatomegaly, there is also a high burden of concomitant morbid pathology. Acute urinary retention can also result from trauma, drug toxicity, infection, or compressive or demyelinating neurologic pathology, and these must be ruled out, particularly in women, children, and elderly patients. This review provides a best-practice approach to the evaluation and management of acute urinary retention in men, women, and children. Evidence-based recommendations are made regarding the approach to difficult catheterizations, imaging, when to obtain specialty consultation, drug therapies, and the importance of follow-up.