Acute urinary retention
| Urinary retention | |
|---|---|
| Synonyms | Ischuria, bladder failure |
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| Urinary retention with greatly enlarged bladder as seen by CT scan. | |
| Specialty | Urology |
| Classification | |
|---|---|
| External resources |
Urinary retention is an inability to completely empty the bladder.
It is most commonly the result of benign prostatic hyperplasia (BPH). Other causes include spinal cord problems, constipation, and medications (including anticholinergics, antidepressants, COX-2 inhibitors, amphetamines, and opioids).
Treatment may require a catheter or prostatic stent.
Urinary retention is characterised by poor urinary stream with intermittent flow, straining, a sense of incomplete voiding, and hesitancy (a delay between trying to urinate and the flow actually beginning). As the bladder remains full, it may lead to incontinence, nocturia (need to urinate at night), and high frequency. Acute retention, causing complete anuria, is a medical emergency, as the bladder can stretch to an enormous size, and possibly tear if not dealt with quickly. If the bladder distends enough, it becomes painful. In such a case, there may be suprapubic constant, dull, pain. The increase in bladder pressure can also prevent urine from entering the ureters or even cause urine to pass back up the ureters and get into the kidneys, causing hydronephrosis, and possibly pyonephrosis, kidney failure, and sepsis. A person should go straight to an emergency department or A&E service as soon as possible if unable to urinate with a painfully full bladder.
In the bladder
In the prostate
Other
Analysis of urine flow may aid in establishing the type of micturition (urination) abnormality. Common findings, determined by ultrasound of the bladder, include a slow rate of flow, intermittent flow, and a large amount of urine retained in the bladder after urination. A normal test result should be 20-25 mL/s peak flow rate. A post-void residual urine greater than 50 ml is a significant amount of urine and increases the potential for recurring urinary tract infections. In adults older than 60 years, 50-100 ml of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. In chronic retention, ultrasound of the bladder may show massive increase in bladder capacity (normal capacity is 400-600 ml).
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