Management of Acute Urinary Retention

Cause of AUR

Initial management, following catheterization

Benign prostatic enlargement

Alpha-blockers for a minimum of 3 days, then trial without catheter (TWOC)

Urethral stricture

Ascending and descending urethrogram

Urinary tract infection

Antibiotics for a minimum of 48 h, then TWOC

Constipation

Laxitives/suppositories/enema, then TWOC

Drugs (e.g. opiate analgesia, anticholinergics, sympathomimetics)

Stop causative agent if possible for >48 h, then TWOC

Spinal cord injury/neurological cause

Leave catheter on free drainage until fully assessed and pathology stable

Post-operative

TWOC when mobile/recovered

Diuresis causing over-distension (medically-induced or secondary to alcohol)

TWOC after 24–48 h

Often there is more than one factor contributing to the AUR. In these cases, all appropriate management strategies will need to be addressed simultaneously.

All patients presenting with AUR should have a serum creatinine check – if this is elevated then a renal ultra-sound scan should be performed to make sure that a case of high-pressure chronic retention is not missed. These patients can have a significant post-obstructive diuresis and will require hospital admission for monitoring of their fluid balance and renal function.

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