Acute Urinary Retention in Men

Background

• Acute urinary retention is the complete inability to voluntarily pass urine, resulting in painful bladder overdistention.
• It is most commonly spontaneous and related to long-standing benign prostatic hypertrophy or precipitated by a triggering event such as surgery, pain, constipation, other obstructive processes, acute medical illness or neurologic condition, urinary infection, or medications.

Evaluation

• Acute urinary retention in men typically presents as being suddenly unable to pass urine with associated intense pain and bladder overdistention.
• Take a complete medical history and perform a digital rectal exam in men with lower urinary tract symptoms (Strong recommendation).
• Consider a bladder ultrasound to measure bladder volume.
• Perform a urinalysis in assessment of lower urinary tract symptoms (Strong recommendation) and measure the postvoid residual (Weak recommendation).
• Consider blood tests to assess renal function and assess for infection, hypovolemia, or hematologic disorders.

Management

• Insert a catheter (transurethral or suprapubic) for immediate drainage of retained urine to provide relief of symptoms. Obtain a urinalysis from the catheterized specimen.
• Consider a trial without catheterization in patients < 70 years old with a smaller prostate and < 1,000 mL of urine at the time of catheterization.
• Begin treatment with an alpha blocker while catheterized. Options include:
  • alfuzosin 10 mg orally once daily
  • doxazosin 1-8 mg orally once daily
  • tamsulosin 0.4-0.8 mg/day
  • terazosin 1-10 mg orally once daily
  • silodosin 8 mg orally once daily, decrease to 4 mg orally once daily if creatinine clearance (CrCl) < 50 mL/minute
  • prazosin 1-2 mg orally twice daily
• In patients with acute urinary retention due to benign prostatic hyperplasia, continue alpha blocker and maintain indwelling catheter if follow-up with a urologist can occur within 3 days.
• Patients with precipitated acute urinary retention should be treated for any known precipitating factor.
• Consider cholinergic agents such as bethanechol or neostigmine for postoperative urinary retention.
• Consider sacral nerve stimulation in men with acute urinary retention not due to obstruction and not responsive to other measures to increase urine volume output and decrease postvoid residual.