urinary retention
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Etiology
(causes not exclusive)
- benign prostatic hypertrophy (BPH)
- postrenal azotemia
- overflow incontinence
- fecal impaction, especially in the elderly
- postoperative complication[9]
- may be contribution of opioid receptor agonist
- pharmaceutical agents
- parasympatholytics (oral, inhaled or parenteral)
- sedating antihistamines (loratadine & fexofenadine are exceptions)
- sympathomimetics prevent bladder neck relaxation
- pseudoephedrine ...
- many cold remedies contain parasympatholytics, sedating antihistamines or sympathomimetics
- opioid receptor agonists[3]
- calcium channel blockers
- alpha-adrenergic agonists[3]
- natural remedies (pharmaceutical herbs)
- herbs containing sympathomimetics
Clinical manifestations
- bladder fullness, palpable bladder
- sensation of incomplete bladder emptying
- urinary frequency
- urinary hesitancy
Laboratory
- basic metabolic panel
- serum creatinine[5]
- serum potassium: hyperkalemia may occur due to RTA-4[3]
- prostate-specific antigen in serum (men)
Diagnostic procedures
- post-void residual (PVR)
- PVR > 200 mL is clearly abnormal
- PVR > 300 mL in symptomatic patients should prompt catheterization
- PVR > 500 mL in asymptomatic patients should prompt catheterization[13]
- bladder scanning preferable to urinary catheter
- intermittent straight catheter preferable to indwelling urinary catheter
- if intermittent straight catheterization is required more than every 4 hours, or urine output is > 500 mL every 4 hours, transition to indwelling urinary catheter[13]
- urodynamic studies can be helpful
Radiology
- CT of pelvis for suspected mass, but not routine[5]
Complications
- delirium (cystocerebral syndrome)
- high 1 year mortality[2]
- 13% without comorbity (18% if NOT due to BPH)
- 29% with comorbidity (41% if NOT due to BPH)
Management
- stop offending medication(s) (step 1, see etiology)
- insert foley catheter as needed
- see post-void residual (PVR) for management of PVR > or < 200 mL
- if due to benign prostatic hypertrophy, start tamsulosin[5][8]
- if benign prostatic hypertrophy complicated by recurrent urinary tract infections, refer to urology for surgical options
- see postrenal azotemia
- suprapubic application of warm wet gauze may stimulate voiding, but lacks from proof of efficacy in controlled trials[9]
More general terms
More specific terms
Additional terms
References
- ↑ Prescriber's Letter 11(1):1 2004
- ↑ 2.0 2.1 Armitage JN et al, Mortality in men admitted to hospital with acute urinary retention: Database analysis. BMJ 2007, Nov 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/17991937 <Internet> http://dx.doi.org/10.1136/bmj.39377.617269.55
- ↑ 3.0 3.1 3.2 3.3 3.4 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Marshall JR, Haber J, Josephson EB. An evidence-based approach to emergency department management of acute urinary retention. Emerg Med Pract. 2014 Jan;16(1):1-20; quiz 21. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24804332
- ↑ 5.0 5.1 5.2 5.3 NEJM Knowledge+ Question of the Week. July 17, 2018 https://knowledgeplus.nejm.org/question-of-week/1216
- ↑ Choong S, Emberton M. Acute urinary retention. BJU Int 2000 Feb 15; 85:186 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10671867 Free full text
- ↑ Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am 2001 Sep 14; 19:591. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11554277
- ↑ 8.0 8.1 Lucas MG, Stephenson TP, Nargund V. Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int 2005 Feb; 95:354. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15679793 Free full text
- ↑ 9.0 9.1 9.2 Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
Bjerregaard LS, Hornum U, Troldborg C et al Postoperative Urinary Catheterization Thresholds of 500 versus 800 ml after Fast-track Total Hip and Knee Arthroplasty: A Randomized, Open-label, Controlled Trial. Anesthesiology. 2016 Jun;124(6):1256-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27054365 - ↑ Stephenson A, Seitz D, Bell CM et al. Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study. Arch Intern Med. 2011;171(10):914-920 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21606096 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227387
- ↑ Billet M, Windsor TA. Urinary retention. Emerg Med Clin North Am. 2019;37(4):649-660 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31563200 https://journals.sagepub.com/doi/10.5301/RU.2013.11688
- ↑ NEJM Knowledge+ Nephrology/Urology
- ↑ 13.0 13.1 13.2 Chrouser K et al. Urinary retention evaluation and catheterization algorithm for adult inpatients. JAMA Netw Open 2024 Jul 16; 7:e2422281. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39012634 PMCID: PMC11252892 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821168