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Management of Acute Urinary Retention in the Emergency Department -

Management of Acute Urinary Retention in the Emergency Department
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Publication Date: March 2021 (Volume 23, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 03/01/2024.


Jonathan Gelber, MD
Department of Emergency Medicine, Highland Hospital, Oakland, CA
Amandeep Singh, MD
Department of Emergency Medicine, Highland Hospital, Oakland, CA

Peer Reviewers

Jeffrey A. Holmes, MD
Assistant Professor of Emergency Medicine, Maine Medical Center and Tufts University School of Medicine
Gregory Podolej, MD, FACEP
Assistant Professor of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois


Etiologies of acute urinary retention fall into 4 broad categories: structural, medication/ toxicologic, neurologic, and infectious. Although two-thirds of cases in men are related to prostatomegaly, there is also a high burden of concomitant morbid pathology. Acute urinary retention can also result from trauma, drug toxicity, infection, or compressive or demyelinating neurologic pathology, and these must be ruled out, particularly in women, children, and elderly patients. This review provides a best-practice approach to the evaluation and management of acute urinary retention in men, women, and children. Evidence-based recommendations are made regarding the approach to difficult catheterizations, imaging, when to obtain specialty consultation, drug therapies, and the importance of follow-up.

Case Presentations

A well-appearing 70-year-old man presents with abdominal pain and an inability to urinate…
  • The patient says he is unable to urinate, so you suspect he has benign prostatic hyperplasia.
  • The patient also complains of cough and runny nose. He appears well otherwise, and you wonder if it is related to his cold...
You are called to the resuscitation bay as EMS unloads a sick-appearing 20-year-old man…
  • The young man’s roommate reports that the patient was first agitated, crying, and picking at his skin, and that he then became unresponsive.
  • The patient has a heart rate of 150 beats/min, temperature of 39.7°C, blood pressure of 159/87 mm Hg, respiratory rate of 12 breaths/min, and oxygen saturation of 100%. His skin is warm and dry.
  • Your respiratory therapist suggests intubation, your nurse suggests antibiotics, your intern suggests naloxone. You have another plan...
A 14-year-old girl presents, accompanied by her father, with a chief complaint of abdominal pain and trouble walking…
  • She describes a week of trouble ambulating, and now she feels too weak to even get out of her chair. She was in the ED yesterday and was discharged home with a diagnosis of viral syndrome.
  • She has mild suprapubic tenderness, some urinary incontinence, but no flank tenderness, fevers, vomiting, or loose stool. She provides a history of diarrheal illness 1 month prior. Her legs have 3/5 strength, and she has no back tenderness.
  • Her urine pregnancy test is negative.
  • You wonder whether this could be a spinal cord process or something else...

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