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.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Meigs J, Barry M, Giovannucci E, et al. Incidence rates and risk factors for acute urinary retention - the health professionals followup. J Urol. 1999;162:376-382. (Survey; 8418 patients) DOI: 10.1016/S0022-5347(05)68563-1
7. * Nevo A, Mano R, Livne PM, et al. Urinary retention in children. Urology. 2014;84(6):1475-1479. (Retrospective; 56 patients) DOI: 10.1016/j.urology.2014.08.020
43. * Ahmad I, Krishna N, Small D, et al. Aetiology and management of acute female urinary retention. Br J Med Surg Urol. 2009;2(1):27-33. (Retrospective; 300 patients) DOI: 10.1016/j.bjmsu.2008.10.004
54. * Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012;367(3):248-257. (Clinical practice guideline) DOI: 10.1056/NEJMcp1106637
73. * Kidd EA, Stewart F, Kassis NC, et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2015 Dec 10;(12):CD004203. (Cochrane review) DOI: 10.1002/14651858.CD004203.pub3
96. * Mcneill SA, Daruwala PD, MItchell ID, et al. Sustained-release alfuzosin and trial without catheter after acute urinary retention. BJU Int. 1999;84:622-627. (Randomized controlled trial; 81 patients) DOI: 10.1046/j.1464-410x.1999.00277.x
97. * Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014 Jun 10;(6):CD006744. (Cochrane review; 9 Randomized controlled trials) DOI: 10.1046/j.1464-410x.1999.00277.x
100. Andriole GL. Benign Prostatic hyperplasia (BPH). Merck Manual. Accessed February 10, 2021. (Online medical reference)
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Keywords: acute urinary retention, AUR, micturition, neurogenic, BPH, prostatomegaly, antihistamine, anticholinergic, opioid, Guillain-Barré, transverse myelitis, cauda equina, zoster, POCUS, catheter, suprapubic, coudé, phimosis, paraphimosis, alfa blocker, diuresis
Jonathan Gelber, MD; Amandeep Singh, MD
Jeffrey A. Holmes, MD; Gregory Podolej, MD, FACEP
March 1, 2021
March 31, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
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