Acute urinary retention is a urologic emergency most common in older men due to benign prostatic hyperplasia. Common causes include BPH, medications, infections, and neurological disorders. Patients present with inability to pass urine and lower abdominal discomfort. Evaluation involves history, physical exam including bladder palpation, and rectal exam. Management is bladder decompression initially with Foley catheter, or emergency suprapubic puncture if catheterization fails. Patients require monitoring after decompression to watch for post-obstructive diuresis.

1. ACUTE URINARY RETENTION
MANAGEMENT
BY :Kemeria Kemal
May,2010

2. INTRODUCTION
• Acute urinary retention (AUR) is the most
common urologic emergency. It occurs most
frequently in men over age 60, and is often the
result of benign prostatic hyperplasia

3. ETIOLOGY
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BPH
Constipation
Prostate cancer
Urethral stricture
Neurologic disorder
Medications/drugs
Urolithiasis
Phimosis or paraphimosis,
Genitourinary infections — acute prostatitis, urethritis,
perianal abscess

4. CLINICAL PRESENTATION
–
AUR presents as the abrupt inability to pass urine.
– It is typically associated with lower abdominal and/or
suprapubic discomfort .
– Affected patients are often restless, and may appear
in considerable distress.

5. EVALUATION
The patient history should focus on a previous history of
retention, surgery, radiation, or pelvic trauma.
The patient should also be asked about the presence of
hematuria , dysuria, fever, low back pain, neurologic
symptoms.
Finally, a complete list of prescribed and over the
counter medications should be obtained.

6. physical examination
– Lower abdominal palpation — The urinary bladder
may be palpable, either on abdominal or rectal
examination.
– Rectal examination — A rectal examination should
be done in both men and women, to evaluate for
masses, fecal impaction, perineal sensation, and
rectal sphincter tone.
– Pelvic examination — Women with urinary retention
should have a pelvic examination.
– Neurologic evaluation

7. MANAGEMENT
1.Bladder decompression with a Foley catheter is
the mainstay of treatment. .
– When a standard Foley catheter cannot be passed easily, sterile
2% viscous lidocaine can be injected through the urethra. This
anesthetizes and relaxes the sphincter, allowing gentle passage
of catheter.
– Catheterization should not be attempted when a urethral injury
is suspected
– Never use force.

8. 2 .Emergency suprapubic puncture with
• A long needle or
• A trocar & plastic tube
Indication;
-when catheterization has failed
-Rapture of the urethera
C/I ;
-An empty bladder(if the pt has extravasation of urine
-Carcinoma of the bladder causing retention
Cxn;
-cellulites
-Injury to the prostate
-Bowl Perforation
-Urinary peritonitis

9. 3. Open suprapubic cystostomy
A , temporary
Indication




When the bladder is not sufficiently distended
Rapture of the bladder
The treatment of clot retention
As a necessary step in a urethroplasty
C/I
-If the pt has carcinoma of the bladder
B , permanent
Indication
 a very tight stricture
 If the pt is too ill for surgery

10. • Patients should be monitored for post obstructive
diuresis. This is a physiologic response to a hypervolemic
state. Occasionally, it can become a pathologic diuresis
and may warrant hospital observation, with fluid and
electrolyte replacement.
• Urine output greater than 200 mL/hour for more than 2
hours should be replaced with 0.5 mL of intravenous
saline for each 1 mL of urine. Electrolytes should be
checked every 6 hours initially and replaced as needed.

11. References
1. UpToDate, Word wide Clinical
Community,2008
2. PRIMARY SURGERY ,vol. 1
3. The Washington manual of surgery, 5th ed