Editing Urinary retention

{{short description|Inability to completely empty the bladder}}
{{Infobox medical condition (new)
| name            = Urinary retention
| synonyms        = Ischuria, bladder failure, bladder obstruction
| image           = Harnverhalt.jpg
| caption         = Urinary retention with greatly enlarged bladder as seen by [[CT scan]].
| field           = [[Emergency medicine]], [[urology]]
| symptoms        = '''Sudden onset''': Inability to urinate, low abdominal pain<ref name=NIH2014/><br>'''Long term''': Frequent urination, loss of bladder control, [[urinary tract infection]]<ref name=NIH2014/>
| complications   =
| onset           =
| duration        =
| types           = Acute, chronic<ref name=NIH2014/>
| causes          = Blockage of the urethra, nerve problems, certain medications, weak bladder muscles<ref name=NIH2014/>
| risks           =
| diagnosis       = Amount of urine in the bladder post urination<ref name=NIH2014/>
| differential    =
| prevention      =
| treatment       = [[urinary catheterization|Catheter]], [[urethral dilation]], [[urethral stents]], surgery<ref name=NIH2014/>
| medication      = [[Alpha blockers]] such as [[terazosin]], [[5α-reductase inhibitors]] such as [[finasteride]]<ref name=NIH2014/>
| prognosis       =
| frequency       = 6 per 1,000 per year (males > 40 years old)<ref name=NIH2014/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Urinary retention''' is an inability to completely empty the [[bladder]].<ref name=NIH2014>{{cite web|title=Urinary Retention|url=https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention|website=[[National Institute of Diabetes and Digestive and Kidney Diseases]]|access-date=24 October 2017|date=August 2014|url-status=live|archive-url=https://web.archive.org/web/20171004190040/https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention|archive-date=4 October 2017}}</ref> Onset can be sudden or gradual.<ref name=NIH2014/> When of sudden onset, symptoms include an inability to urinate and lower abdominal pain.<ref name=NIH2014/> When of gradual onset, symptoms may include [[urinary incontinence|loss of bladder control]], mild lower abdominal pain, and a weak urine stream.<ref name=NIH2014/> Those with long-term problems are at risk of [[urinary tract infection]]s.<ref name=NIH2014/>

<!-- Cause and diagnosis -->
Causes include blockage of the [[urethra]], nerve problems, certain medications, and weak bladder muscles.<ref name=NIH2014/> Blockage can be caused by [[benign prostatic hyperplasia]] (BPH), [[urethral stricture]]s, [[bladder stones]], a [[cystocele]], [[constipation]], or [[tumors]].<ref name=NIH2014/> Nerve problems can occur from [[diabetes]], trauma, [[spinal cord injury|spinal cord problems]], [[stroke]], or [[heavy metal poisoning]].<ref name=NIH2014/> Medications that can cause problems include [[anticholinergic]]s, [[antihistamines]], [[tricyclic antidepressants]], [[cyclobenzaprine]], [[diazepam]], [[nonsteroidal anti-inflammatory drug]]s (NSAID), [[stimulants]], and [[opioid]]s.<ref name=NIH2014/><ref name=acdj>{{cite journal | vauthors = de Jong AC, Maaskant JM, Groen LA, van Woensel JB | title = Monitoring of micturition and bladder volumes can replace routine indwelling urinary catheters in children receiving intravenous opioids: a prospective cohort study | journal = European Journal of Pediatrics | volume = 180 | issue = 1 | pages = 47–56 | date = January 2021 | pmid = 32529397 | pmc = 7782390 | doi = 10.1007/s00431-020-03703-7 }}</ref> Diagnosis is typically based on measuring the amount of urine in the bladder after urinating.<ref name=NIH2014/>

<!-- Treatment and epidemiology-->
Treatment is typically with a [[urinary catheterization|catheter]] either through the urethra or [[suprapubic catheter|lower abdomen]].<ref name=NIH2014/><ref>{{cite journal | vauthors = Sliwinski A, D'Arcy FT, Sultana R, Lawrentschuk N | title = Acute urinary retention and the difficult catheterization: current emergency management | journal = European Journal of Emergency Medicine | volume = 23 | issue = 2 | pages = 80–88 | date = April 2016 | pmid = 26479738 | doi = 10.1097/MEJ.0000000000000334 | s2cid = 26988888 }}</ref> Other treatments may include medication to decrease the size of the prostate, urethral dilation, a [[urethral stent]], or surgery.<ref name=NIH2014/> Males are more often affected than females.<ref name=NIH2014/> In males over the age of 40 about 6 per 1,000 are affected a year.<ref name=NIH2014/> Among males over 80 this increases 30%.<ref name=NIH2014/>

== Signs and symptoms ==
Onset can be sudden or gradual.<ref name=NIH2014/> When the onset is sudden, symptoms include an inability to urinate and lower abdominal pain.<ref name=NIH2014/> When of gradual onset, symptoms may include [[urinary incontinence|loss of bladder control]], mild lower abdominal pain, and a weak urine stream.<ref name=NIH2014/> Those with long-term problems are at risk of [[urinary tract infection]]s.<ref name=NIH2014/>
=== Complications ===
[[File:Sequence 02 1.ogv|thumb|The urinary bag of a person with post obstructive diuresis]]
Acute urinary retention is a [[medical emergency]] and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover, one can develop severe [[perspiration|sweating]], [[chest pain]], [[anxiety]] and [[hypertension|high blood pressure]]. Other patients may develop a shock-like condition and may require admission to a hospital. Serious complications of untreated urinary retention include [[urinary bladder|bladder]] damage and chronic [[renal failure|kidney failure]].<ref>{{cite web | url = http://www.retentionurinary.com/ | title = General information on urinary retention | archive-url = https://web.archive.org/web/20100220120543/http://www.retentionurinary.com/ | archive-date = 20 February 2010 | work = Retention Urinary }}</ref> Urinary retention is a disorder treated in a hospital, and the quicker one seeks treatment, the fewer the complications.{{cn|date=April 2021}}

In the longer term, obstruction of the urinary tract may cause:{{cn|date=April 2021}}
* [[Bladder stone]]s
* [[Atrophy]] of the [[detrusor muscle]] (atonic bladder is an extreme form)
* [[Hydronephrosis]] (congestion of the kidneys)
* [[Hypertrophy]] of the [[detrusor muscle]] (the muscle that squeezes the bladder to empty it during urination)
* [[Diverticula]] (formation of pouches) in the bladder wall (which can lead to stones and infection)

== Causes ==

===Bladder===
* Infection<ref>{{cite journal | vauthors = Khasriya R, Barcella W, [[Maria De Iorio|De Iorio M]], Swamy S, Gill K, Kupelian A, Malone-Lee J | title = Lower urinary tract symptoms that predict microscopic pyuria | journal = International Urogynecology Journal | volume = 29 | issue = 7 | pages = 1019–1028 | date = July 2018 | pmid = 28971220 | pmc = 6004270 | doi = 10.1007/s00192-017-3472-7 }}</ref>
* [[Bladder sphincter dyssynergia|Detrusor sphincter dyssynergia]]
* [[Neurogenic bladder dysfunction|Neurogenic bladder]] (commonly spinal cord damage, pelvic splanchic nerve damage, cauda equina syndrome,  pontine micturition or storage center lesions, [[demyelinating diseases]], [[multiple system atrophy]], [[genital herpes]], or [[meningitis-retention syndrome]])
* [[Iatrogenesis|Iatrogenic]] (caused by medical treatment/procedure) scarring of the bladder neck (commonly from removal of indwelling [[catheters]] or [[cystoscopy]] operations)
* Damage to the bladder

===Prostate===
* [[Benign prostatic hyperplasia]] (BPH)
* [[Prostate cancer]] and other pelvic [[cancer|malignancies]]
* [[Prostatitis]]

===Penile urethra===
* [[Congenital urethral valves]]
* [[Phimosis]] or pinhole meatus
* [[Circumcision]]
* Obstruction in the urethra, for example a stricture (usually caused either by injury or STD), a metastasis or a precipitated [[pseudogout]] crystal in the urine
* [[Pseudodyssynergia]]
* STD lesions ([[Gonorrhea|gonorrhoea]] causes numerous strictures, leading to a "rosary bead" appearance, whereas chlamydia usually causes a single stricture)
* [[Emasculation]]

===Postoperative===
Risk factors include
* Age: Older people may have [[Degeneration (medical)|degeneration]] of [[neural pathway]]s involved with bladder function and it can lead to an increased risk of postoperative urinary retention.<ref name=":7">{{cite journal | vauthors = Kowalik U, Plante MK | title = Urinary Retention in Surgical Patients | journal = The Surgical Clinics of North America | volume = 96 | issue = 3 | pages = 453–467 | date = June 2016 | pmid = 27261788 | doi = 10.1016/j.suc.2016.02.004 }}</ref> The risk of postoperative urinary retention increases up to 2.11 fold for people older than 60 years.<ref name=":7" />
* Medications: [[Anticholinergics]] and medications with anticholinergic properties, [[alpha-adrenergic agonist]]s, [[opiate]]s, nonsteroidal anti-inflammatories (NSAIDs), [[Calcium channel blocker|calcium-channel blockers]] and [[beta-adrenergic agonist]]s, may increase the risk.<ref name=acdj/><ref name=":7" />
* Anesthesia: General anesthetics during surgery may cause bladder [[atony]] by acting as a smooth muscle relaxant.<ref name=":7" /> General anesthetics can directly interfere with autonomic regulation of [[Detrusor muscle|detrusor]] tone and predispose people to bladder overdistention and subsequent retention.<ref name=":7" /> Spinal anesthesia results in a blockade of the [[Urination|micturition reflex]].<ref name=":7" /> Spinal anesthesia shows a higher risk of postoperative urinary retention compared to general anesthesia.<ref name=":7" />
* [[Benign prostatic hyperplasia]]: Men with benign prostatic hyperplasia are at an increased risk of acute urinary retention.<ref name=":7" />
* Surgery related: Operative times longer than 2 hours may lead to an increased risk of postoperative urinary retention 3-fold.<ref name=":7" />
* Postoperative pain.<ref name=":7" />

===Chronic===
Chronic urinary retention that is due to bladder blockage which can either be as a result of muscle damage or neurological damage.<ref name="Stof2017" /> If the retention is due to neurological damage, there is a disconnect between the brain to muscle communication, which can make it impossible to completely empty the bladder.<ref name="Stof2017" /> If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.<ref name="Stof2017" />

The most common cause of chronic urinary retention is BPH.<ref name="NIH2014" />

===Other===
* [[Tethered spinal cord syndrome]].{{cn|date=May 2025}}
* [[Somatic symptom disorder|Psychogenic]] causes – psychosocial stresses, fear associated with urination, [[paruresis]] ("shy bladder syndrome") – in extreme cases, urinary retention can result.{{cn|date=May 2025}}
* [[noradrenergic]] drugs, that includes [[tricyclic antidepressants]], as well as [[duloxetine]], [[reboxetine]], [[atomoxetine]], [[venlafaxine]],<ref>{{Cite journal |last1=Whiskey |first1=Eromona |last2=Taylor |first2=David |date=2013 |title=A review of the adverse effects and safety of noradrenergic antidepressants |journal=Journal of Psychopharmacology |language=en |volume=27 |issue=8 |pages=732–739 |doi=10.1177/0269881113492027 |pmid=23784737 |issn=0269-8811}}</ref> and [[stimulant]]s, such as [[methylphenidate]], [[amphetamine]] and [[Methylenedioxymethamphetamine|MDMA]].
* Use of NSAIDs, or drugs with [[anticholinergic]] properties.{{cn|date=May 2025}}
* Stones or metastases, which can theoretically appear anywhere along the urinary tract, but vary in frequency depending on anatomy.{{cn|date=May 2025}}
* [[Muscarinic antagonist]]s such as [[atropine]] and [[Hyoscine hydrobromide|scopolamine]].{{cn|date=May 2025}}
* Malfunctioning [[artificial urinary sphincter]].{{cn|date=May 2025}}

== Diagnosis ==
[[File:Urinaryobstruction.png|thumb|As seen on axial CT]]
[[File:Ultrasound of trabeculated urinary bladder.jpg|thumb|[[Medical ultrasonography|Ultrasonography]] showing a trabeculated wall, seen as small irregularities mainly at left (superior part). This is strongly associated with urinary retention.<ref>{{cite book|title=Glenn's Urologic Surgery|url=https://books.google.com/books?id=GahMzaKgMKAC&pg=PA306 |page=306 | vauthors = Graham SE, Keane TE, Glenn JF |publisher=Lippincott Williams & Wilkins|year=2010|isbn=978-0-7817-9141-0}}</ref>]]
Analysis of urine flow may aid in establishing the type of [[micturition]] (urination) abnormality. Common findings, determined by ultrasound of the bladder, include a slow rate of flow, intermittent flow, and a large amount of urine retained in the bladder after urination. A normal test result should be 20–25&nbsp;[[Milliliter|ml]]/s peak flow rate. A post-void residual urine greater than 50&nbsp;ml is a significant amount of urine and increases the potential for recurring urinary tract infections.{{cn|date=July 2022}} In adults older than 60 years, 50-100&nbsp;ml of residual urine may remain after each voiding because of the decreased contractility of the [[Detrusor urinae muscle|detrusor muscle]].<ref name="Stof2017" /> In chronic retention, ultrasound of the bladder may show massive increase in bladder capacity (normal capacity is 400-600&nbsp;ml).{{cn|date=April 2021}}

Non-neurogenic chronic urinary retention does not have a standardized definition; however, urine volumes >300mL can be used as an informal indicator.<ref name=Stof2017>{{cite journal | vauthors = Stoffel JT | title = Non-neurogenic Chronic Urinary Retention: What Are We Treating? | journal = Current Urology Reports | volume = 18 | issue = 9 | pages = 74 | date = September 2017 | pmid = 28730405 | doi = 10.1007/s11934-017-0719-2 | s2cid = 12989132 }}</ref> Diagnosis of urinary retention is conducted over a period of 6 months, with 2 separate measurements of urine volume 6 months apart. Measurements should have a PVR (post-void residual) volume of >300ml.<ref name=Stof2017/>

Determining the serum [[prostate-specific antigen]] (PSA) may help diagnose or rule out prostate cancer, though this is also raised in BPH and [[prostatitis]]. A [[TRUS]] biopsy of the prostate (transrectal ultrasound guided) can distinguish between these prostate conditions. Serum [[urea]] and [[creatinine]] determinations may be necessary to rule out backflow kidney damage. [[Cystoscopy]] may be needed to explore the urinary passage and rule out blockages.{{cn|date=April 2021}}

In acute cases of urinary retention where associated symptoms in the lumbar spine are present such as pain, numbness ([[saddle anesthesia]]), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess [[cauda equina syndrome]].{{cn|date=April 2021}}

== Treatment ==
In acute urinary retention, [[urinary catheterization]], placement of a [[prostatic stent]], or [[suprapubic cystostomy]] relieves the retention. In the longer term, treatment depends on the cause. BPH may respond to [[alpha blocker]] and [[5-alpha-reductase inhibitor]] therapy, or surgically with [[prostatectomy]] or [[transurethral resection of the prostate]] (TURP).{{cn|date=April 2021}}

Use of alpha-blockers can provide relief of urinary retention following de-catheterization for both men and women.<ref>{{cite journal | vauthors = Fisher E, Subramonian K, Omar MI | title = The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD006744 | date = June 2014 | pmid = 24913721 | doi = 10.1002/14651858.CD006744.pub3 | doi-access = free | pmc = 11214126 }}</ref><ref>{{cite journal | vauthors = Mevcha A, Drake MJ | title = Etiology and management of urinary retention in women | journal = Indian Journal of Urology | volume = 26 | issue = 2 | pages = 230–235 | date = April 2010 | pmid = 20877602 | pmc = 2938548 | doi = 10.4103/0970-1591.65396 | doi-access = free }}</ref> In case, if catheter can't be negotiated, suprapubic puncture can be done with lumbar puncture needle.{{cn|date=May 2025}}

===Medication===
====α1-receptor antagonists and 5α-reductase inhibitors====
Urinary retention, including drug-induced cases, may be an early sign of [[benign prostatic hyperplasia]] (BPH). Treatment typically includes [[Alpha-1 blocker|α1-receptor antagonists]] such as [[tamsulosin]], which relaxes [[internal urethral sphincter|smooth muscle in the bladder neck]], and [[5α-reductase inhibitor]]s like [[finasteride]] and [[dutasteride]], which reduce prostate enlargement. Clinical trials have demonstrated that combining these medications improves urinary symptoms and lowers the likelihood of retention recurrence.<ref name="Verhamme2008">{{Cite journal |last1=Verhamme |first1=Katia M C |last2=Sturkenboom |first2=Miriam C J M |last3=Stricker |first3=Bruno H Ch |last4=Bosch |first4=Ruud |date=2008 |title=Drug-Induced Urinary Retention: Incidence, Management and Prevention |journal=Drug Safety |language=en |volume=31 |issue=5 |pages=373–388 |doi=10.2165/00002018-200831050-00002 |pmid=18422378 |issn=0114-5916}}</ref>

====Striated muscle relaxants====
[[Baclofen]], a [[gamma-aminobutyric acid]] (GABA) agonist, acts on GABAergic [[interneuron]]s in the [[sacrum|sacral]] [[intermediolateral nucleus|intermediolateral cell column]], facilitating the relaxation of the [[external sphincter muscle of urethra|striated urinary sphincter]] during voiding. Some evidence suggests it may be beneficial for women with [[bladder outlet obstruction]]<ref name="EAU2024">{{Cite web |last1=Harding |first1=C.K. |last2=Lapitan |first2=M.C. |last3=Arlandis |first3=S. |last4=Bø |first4=K. |last5=Cobussen-Boekhorst |first5=H. |last6=Costantini |first6=E. |last7=Groen |first7=J. |last8=Nambiar |first8=A.K. |last9=Omar |first9=M.I. |last10=Peyronnet |first10=B. |last11=Phé |first11=V. |last12=van der Vaart |first12=C.H. |date=2024 |title=European Association of Urology Guidelines on Management of Non-Neurogenic Female Lower Urinary Tract Symptoms |url=https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management |url-status=live |archive-url=https://web.archive.org/web/20240811120201/https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management |archive-date=2024-08-11 |access-date=2025-02-08 |website=EAU Guidelines |publisher=EAU Guidelines Office |location=Arnhem, The Netherlands}}</ref> and pediatric patients.<ref name="Tousignant2025">{{Cite journal |last1=Tousignant |first1=Angélique |last2=Blais |first2=Marc-Antoine |last3=Tu |first3=Le Mai |last4=Morin |first4=Mélanie |last5=Ismail |first5=Salima |date=2025-02-03 |title=A Scoping Review of the Oral Treatment Options for the Management of Detrusor Sphincter Dyssynergia |journal=Neurourology and Urodynamics |language=en |doi=10.1002/nau.25642 |issn=0733-2467|doi-access=free |pmid=39898415 |pmc=12018650 }}</ref>

====Opioid antagonists====
[[Naloxone]], has been tested for urinary retention following [[epidural]] or [[intrathecal]] anesthesia. While effective, it also reverses [[analgesia]], making it unsuitable for postoperative cases. [[Nalbuphine]], a [[agonist-antagonist|mixed agonist/antagonist]] [[opioid modulator]], has shown promise in a reported case of postoperative urinary retention, preserving analgesia while relieving retention. Further studies are needed to confirm its efficacy.<ref name="Verhamme2008"/>

=== Pelvic floor muscle training and biofeedback ===
[[Kegel exercise|Pelvic floor muscle training]] (PFMT), sometimes combined with [[biofeedback]], is a treatment that aim to teach patients to relax their pelvic floor muscles (PFMs) and [[external sphincter muscle of urethra|striated urinary sphincter]] during voiding.  It has been shown that pelvic floor muscle contraction, especially in women with pelvic floor dysfunction, can significantly reduce vaginal resting pressure and surface [[electromyography]] (EMG) activity.  However, the majority of evidence supporting PFMT for dysfunctional voiding comes from studies of children, not adults.<ref name="EAU2024"/>

=== Electrical stimulation ===
Electrical stimulation, or [[neuromodulation]] involves the application of [[electrodes]] to induce controlled contraction and relaxation of the pelvic floor muscles. The goal of this intervention is to facilitate relaxation of the [[external sphincter muscle of urethra|external sphincter]] and [[pelvic floor]] muscles, which may assist in voiding.<ref name="EAU2024"/> Different methods of electrical stimulation are used, including:
* [[Transcutaneous electrical nerve stimulation]] (TENS): This [[Food and Drug Administration|FDA]]-approved method involves applying electrodes to the skin. TENS has been studied as a treatment for [[idiopathic]] non-obstructive urinary retention (NOUR).<ref name="Groat2015">{{Cite journal |last1=de Groat |first1=William C. |last2=Tai |first2=Changfeng |date=2015 |title=Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function |journal=Bioelectronic Medicine |language=en |volume=2 |issue=1 |pages=25–36 |doi=10.15424/bioelectronmed.2015.00003 |issn=2332-8886 |doi-access=free}}</ref> Studies show that TENS can be applied at different locations, such as transvaginally, over the [[Pubic symphysis|symphysis pubis]] and [[ischial tuberosity]]<ref name="Coolen2021">{{Cite journal |last1=Coolen |first1=Rosa L. |last2=Groen |first2=Jan |last3=Scheepe |first3=Jeroen R. |last4=Blok |first4=Bertil F.M. |date=2021 |title=Transcutaneous Electrical Nerve Stimulation and Percutaneous Tibial Nerve Stimulation to Treat Idiopathic Nonobstructive Urinary Retention: A Systematic Review |journal=European Urology Focus |language=en |volume=7 |issue=5 |pages=1184–1194 |doi=10.1016/j.euf.2020.09.019|pmid=33268327 }}</ref> to stimulate the [[pudendal nerve]],<ref name="Jezernik2002">{{Cite journal |last1=Jezernik |first1=Sašo |last2=Craggs |first2=Michael |last3=Grill |first3=Warren M. |last4=Creasey |first4=Graham |last5=Rijkhoff |first5=Nico J. M. |date=2002 |title=Electrical stimulation for the treatment of bladder dysfunction: Current status and future possibilities |journal=Neurological Research |language=en |volume=24 |issue=5 |pages=413–430 |doi=10.1179/016164102101200294 |pmid=12117310 |issn=0161-6412}}</ref><ref name="Grill2009">{{Cite book |last=Grill |first=W.M. |chapter=Electrical stimulation for control of bladder function |date=2009 |title=2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society |chapter-url=https://ieeexplore.ieee.org/document/5335001 |publisher=IEEE |pages=2369–2370 |doi=10.1109/iembs.2009.5335001 |pmc=3663041 |pmid=19965189}}</ref> or at the [[Sacral spinal nerve 2|second sacral foramina]] and lower abdomen.<ref name="Coolen2021"/>
:In adults with idiopathic NOUR, transvaginal TENS has demonstrated a subjective success rate of 80% with patients reporting a stronger stream when voiding. Another study showed that TENS applied to the sacral foramina and lower abdomen combined with conservative treatment resulted in a 43% decrease in the number of patients relying on catheterization.<ref name="Coolen2021"/>
:In children with idiopathic NOUR, TENS combined with [[Kegel exercise|pelvic floor muscle training]] reduced postvoid residual and urinary tract infections.<ref name="Coolen2021"/>
* [[Percutaneous tibial nerve stimulation]] (PTNS): This minimally invasive [[Food and Drug Administration|FDA]]-approved method involves placing a needle electrode near the tibial nerve.<ref name="Groat2015"/> The objective success rate of PTNS (defined as a 50% or greater decrease in catheterizations or catheterized volume) ranges from 25% to 41%. Subjective success rates, based on patient's desire to continue treatment, range from 46.7% to 59%.<ref name="Coolen2021"/>
* Implantable neuromodulator devices: An implantable device is used to [[Sacral nerve stimulation|stimulate the sacral nerves]] leading to the contraction of the [[detrusor muscle]]. This technique can be combined with [[Selective dorsal rhizotomy|posterior rhizotomy]] to reduce detrusor hyperreflexia.<ref name="Jezernik2002"/>

=== Extracorporeal magnetic stimulation ===
Extracorporeal magnetic stimulation is a non-invasive method that involves the patient sitting on a device that induces consistent [[pelvic floor]] muscles contraction and relaxation at a set frequency and interval by repeated magnetic stimulation of motor nerves.<ref name="EAU2024"/>

=== Catheter ===
Acute urinary retention is treated by placement of a urinary catheter (small thin flexible tube) into the bladder. This can be either an [[intermittent catheter]] or a [[Foley catheter]] that is placed with a small inflatable bulb that holds the catheter in place.{{cn|date=April 2021}}

Intermittent catheterization can be done by a health care professional or by the person themselves (clean intermittent self catheterization).  Intermittent catheterization performed at the hospital is a sterile technique. Patients can be taught to use a [[self catheterization]] technique in one simple demonstration,<ref name=":0" /> and that reduces the rate of infection from long-term Foley catheters. Self catheterization requires doing the procedure periodically during the day, the frequency depending on fluid intake and bladder capacity. If fluid intake/outflow is around 1.5 litres per day, this would typically be performed roughly three times per day, i.e. roughly every six to eight hours during the day, more frequently when fluid intake is higher and/or bladder capacity lower.

For acute urinary retention, treatment requires urgent placement of a urinary catheter. A permanent urinary catheter may cause discomfort and pain that can last several days.

Older people with ongoing problems may require continued intermittent self catheterization (CISC). CISC has a lower infection risk compared to catheterization techniques that stay within the body.<ref name=":0">{{cite news | vauthors = Sherman ND |url=https://www.nytimes.com/health/guides/specialtopic/clean-intermittent-self-catheterization/overview.html | archive-url = https://web.archive.org/web/20160206072546/https://www.nytimes.com/health/guides/specialtopic/clean-intermittent-self-catheterization/overview.html | archive-date = 6 February 2016 |title=Clean Intermittent Self-Catheterization |newspaper=The New York Times |url-status=dead }}</ref>

Challenges with CISC include compliance issues as some people may not be able to place the catheter themselves.<ref>{{cite journal | vauthors = Seth JH, Haslam C, Panicker JN | title = Ensuring patient adherence to clean intermittent self-catheterization | journal = Patient Preference and Adherence | volume = 8 | pages = 191–198 | date = 2014 | pmid = 24611001 | pmc = 3928402 | doi = 10.2147/PPA.S49060 | doi-access = free }}</ref>

===Surgery===
The [[chronic (medicine)|chronic]] form of urinary retention may require some type of [[surgery|surgical]] procedure. While both procedures are relatively safe, complications can occur.

In most patients with [[benign prostate hyperplasia]] (BPH), a procedure known as [[transurethral resection of the prostate]] (TURP) may be performed to relieve bladder obstruction.<ref>{{cite web | work = eMedicine Health | url = http://www.emedicinehealth.com/inability_to_urinate/article_em.htm | vauthors = Ellsworth PI | veditors = Stöppler MC | title = Inability to urinate | archive-url = https://web.archive.org/web/20100305211901/http://www.emedicinehealth.com/inability_to_urinate/article_em.htm | archive-date= 5 March 2010 | date = 10 February 2010 }}</ref> Surgical complications from TURP include a bladder infection, bleeding from the prostate, scar formation, inability to hold urine, and inability to have an erection. The majority of these complications are short lived, and most individuals recover fully within 6–12 months.<ref>{{cite web | work = National Kidney and Urologic Diseases Information Clearinghouse | url = http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/index.htm | title = Urinary retention overview | archive-url = https://web.archive.org/web/20100129010448/http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/index.htm | archive-date = 29 January 2010 | access-date = 10 February 2010 }}</ref>

===Sitting voiding position===
A [[meta-analysis]] on the influence of voiding position on [[urodynamics]] in males with [[lower urinary tract symptoms]] showed that in the sitting position, the residual urine in the bladder was significantly reduced, the maximum urinary flow was increased, and the voiding time was decreased. For healthy males, no influence was found on these parameters, meaning that they can urinate in either position.<ref>{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | year = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }}</ref>

== Epidemiology ==
Urinary retention is a common disorder in elderly males. The most common cause of urinary retention is BPH. This disorder starts around age 50 and symptoms may appear after 10–15 years. BPH is a progressive disorder and narrows the neck of the bladder leading to urinary retention. By the age of 70, almost 10 percent of males have some degree of BPH and 33% have it by the eighth decade of life. While BPH rarely causes sudden urinary retention, the condition can become acute in the presence of certain medications including [[antihypertensive]]s, [[antihistamine]]s, and [[Management of Parkinson's disease#Medication|antiparkinson]] medications, and after [[spinal anaesthesia]] or [[stroke]].{{cn|date=April 2021}}

In young males, the most common cause of urinary retention is infection of the prostate (''acute [[prostatitis]]''). The infection is acquired during sexual intercourse and presents with low back pain, penile discharge, low grade [[fever]] and an inability to pass urine. The exact number of individuals with acute prostatitis is unknown, because many do not seek treatment. In the US, at least 1–3 percent of males under the age of 40 develop urinary difficulty as a result of acute prostatitis. Most physicians and other health care professionals are aware of these disorders. Worldwide, both BPH and acute prostatitis have been found in males of all races and ethnic backgrounds. Cancers of the urinary tract can cause urinary obstruction but the process is more gradual. [[Bladder cancer|Cancer of the bladder]], [[Prostate cancer|prostate]] or [[Ureter cancer|ureters]] can gradually obstruct urine output. Cancers often present with [[Hematuria|blood in the urine]], [[weight loss]], lower back pain or gradual distension in the flanks.<ref>{{cite web | url = http://www.urologychannel.com/emergencies/acute.shtml | title = Urologic Emergencies | archive-url = https://web.archive.org/web/20100310143204/http://www.urologychannel.com/emergencies/acute.shtml | archive-date = 10 March 2010 |  work = Urology Channel Portal | date = 10 February 2010 }}</ref>

Urinary retention in females is uncommon, occurring 1 in 100,000 every year, with a female-to-male incidence rate of 1:13. It is usually transient. The causes of UR in women can be multi-factorial, and can be postoperative and postpartum. Prompt urethral catheterization usually resolves the problem.<ref>{{cite journal | vauthors = Özveren B, Keskin S | title = Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients | journal = Urology Annals | volume = 8 | issue = 4 | pages = 444–448 | date = 2016 | pmid = 28057989 | pmc = 5100150 | doi = 10.4103/0974-7796.192111 | doi-access = free }}</ref>

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|   ICD10       = {{ICD10|R|33||r|30}}
|   ICD9        = {{ICD9|788.2}}
|   MeshID      = D016055
|   DiseasesDB  = 13582
}}
{{Urinary system symptoms and signs}}
{{Authority control}}

{{DEFAULTSORT:Urinary Retention}}
[[Category:Symptoms and signs: Urinary system]]
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[[Category:Acute pain]]
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