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Urinary retention is incomplete emptying of the bladder or cessation of urination; it may be acute or chronic. Causes include impaired bladder contractility, bladder outlet obstruction, detrusor-sphincter dyssynergia (lack of coordination between bladder contraction and sphincter relaxation), or a combination. Retention is most common among men, in whom prostate abnormalities or urethral strictures cause outlet obstruction. In either sex, retention may be due to drugs (particularly those with anticholinergic effects, including many OTC drugs), severe fecal impaction (which increases pressure on the bladder trigone), or neurogenic bladder in patients with diabetes, multiple sclerosis, Parkinson's disease, or prior pelvic surgery resulting in bladder denervation.
Urinary retention can cause urinary frequency and urge or overflow incontinence. It may cause abdominal distention and pain. When retention develops slowly, pain may be absent. Long-standing retention predisposes to UTI and can increase bladder pressure, causing obstructive uropathy (see Obstructive Uropathy).
Diagnosis is obvious in patients who cannot void. In those who can void, diagnosis is by postvoid catheterization showing a residual urine volume > 100 mL. Other tests (eg, urinalysis, blood tests, ultrasonography, urodynamic testing, cystoscopy, cystography) are done based on clinical findings.
Relief of acute urinary retention requires urethral catheterization. Subsequent treatment depends on cause. In men with benign prostatic hypertrophy, drugs (usually α-adrenergic blockers or 5α-reductase inhibitors) or surgery may help decrease bladder outlet resistance. No treatment is effective for impaired bladder contractility or a neurogenic bladder; intermittent self-catheterization or indwelling catheterization is usually required. Urinary diversion is a last resort.
Last full review/revision August 2007 by Paul D. Lui, MD
Content last modified August 2007
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