Urinary Retention

Acute urinary retention is the sudden inability to void. It is a common problem that usually causes agonizing suprapubic pain that demands urgent relief.

ETIOLOGY

Acute urinary retention most commonly occurs in patients who have preexisting partial bladder outlet obstruction and experience a decrease in detrusor pressures or a sudden increase in outlet resistance. Frequent precipitating events include drugs (such as α-agonists, anticholinergics, antihistamines, analgesics, and anesthetics), acute infection, bleeding, or overdistention of the bladder (e.g., which can happen after anesthesia or alcohol).

Benign Prostatic Hyperplasia

Patients with increasing outlet resistance secondary to benign prostatic hyperplasia (BPH) may go into acute urinary retention by delaying voiding. With overdistention, the already weakened detrusor will become atonic. Edema from acute infection (e.g., prostatitis) can also send the patient into retention.

Stricture

An acute event such as infection, bleeding, and overdistention of the bladder can cause the patient with severe stricture disease to go into retention.

Blood Clots

Acute clot retention can occur secondary to bleeding from BPH or bladder tumor or be a late complication from transurethral resection of the prostate, particularly in patients on anticoagulants. Sloughing of a scab within the prostatic fossa can
produce significant bleeding with clot formation. Prostate needle biopsy can also be a precipitating event.

Bladder Neck Contracture

A tight scar formed at the bladder neck after transurethral resection of the prostate can lead to retention if infection, bleeding, or acute overdistention of the bladder occurs.

Prostate Cancer

Urinary retention can occur in patients with advanced cancer of the prostate. Patients will often give a history of rapid onset of obstructive voiding symptoms as opposed to the more gradual onset usually noted with BPH.

Myopathic Bladder

Detrusor myopathy can result from overdistention of the bladder. This is most frequently seen after surgery when the normal voiding pattern is delayed while the patient recovers from anesthesia.

Neuropathic Bladder

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