Urinary retention is the inability to empty the bladder when a person voids (micturition) or the

accumulation of urine in the bladder because of an inability to urinate. In certain cases, it is

associated with urinary leakage or postvoid dribbling, called overflow UI. Acute urinary
retention is the total inability to pass urine via micturition. It is a medical emergency. Chronic
urinary retention is an incomplete bladder emptying despite urination.
The postvoid residual (PVR) volumes in patients with chronic urinary retention vary widely.
Normal PVR is between 50 and 75 mL. Findings over 100 mL indicate the need to repeat the
measurement. An abnormal PVR in the older patient of more than 200 mL obtained on two
separate occasions requires further evaluation. Even smaller volumes may justify further
evaluation when the patient has recurring UTIs or lower urinary tract symptoms suggestive of
UTI.
Etiology and Pathophysiology
Urinary retention is caused by two different dysfunctions of the urinary system: bladder outlet
obstruction and deficient detrusor (bladder muscle) contraction strength. Bladder outlet
obstruction leads to urinary retention when the blockage is so severe that the bladder can no
longer evacuate its contents despite a detrusor contraction. A common cause of obstruction in
men is an enlarged prostate. Deficient detrusor contraction strength leads to urinary retention
when the muscle is no longer able to contract with enough force or for a sufficient time to
completely empty the bladder. Common causes of deficient detrusor contraction strength are
neurologic diseases affecting sacral segments 2, 3, and 4; longstanding diabetes mellitus;
overdistention; chronic alcoholism; and drugs (e.g., anticholinergic drugs).
MANAGEMENT
Behavioral therapies that were described for UI may also be used in the management of urinary
retention. Scheduled toileting and double voiding may be effective in chronic urinary retention
with moderate PVR volumes. Double voiding is an attempt to maximize bladder evacuation. The
patient is asked to urinate, sit on the toilet for 3 to 4 minutes, and urinate again before exiting the
bathroom. For acute or chronic urinary retention, catheterization may be required. Intermittent
catheterization allows the patient to remain free of an indwelling catheter with its associated risk
of UTI and urethral irritation. In some situations, an indwelling catheter is preferred (e.g., if the
patient is unwilling or unable to perform intermittent catheterization). An indwelling catheter is
also used when urethral obstruction makes intermittent catheterization uncomfortable or
infeasible.
Drug Therapy. Several drugs may be administered to promote bladder evacuation. For the
patient with obstruction at the level of the bladder neck, an α-adrenergic blocker may be
prescribed. These drugs relax the smooth muscle of the bladder neck, the prostatic urethra, and
possibly the rhabdosphincter, diminishing urethral resistance. Examples of α-adrenergic blocking
agents are listed in Table 46-20. They are indicated in patients with BPH, bladder neck
dyssynergia (muscle incoordination), or detrusor sphincter dyssynergia.
Surgical Therapy. Surgical interventions are used to manage urinary retention caused by
obstruction. Transurethral or open surgical techniques are used to treat benign or malignant
prostatic enlargement, bladder neck contracture, urethral strictures, or dyssynergia of the bladder
neck. Pelvic reconstruction using an abdominal or transvaginal approach can correct bladder
outlet obstruction in women with severe pelvic organ prolapse.
Unfortunately, surgery has a minimal role in the management of urinary retention caused by
deficient detrusor contraction strength. Attempts to create a bladder stimulator (implanted device
capable of stimulating micturition) have proved largely unsuccessful because of the difficulty in
achieving a coordinated detrusor contraction associated with pelvic muscle and striated sphincter
relaxation.