Urinary Retention

Editor: Daniele Mindardi

Last Updated June 2018

Current definitions (1)

Urinary retention - complaint of the inability to pass urine despite persistent effort. Acute retention of urine - this is defined as a generally (but not always) painful, palpable, or percussable bladder, when the patient is unable to pass any urine when the bladder is full.

Chronic retention of urine (CUR) - this is defined as a non-painful bladder, where there is a chronic high PVR.

History

According to Abrams et al (2) Acute retention of urine this is defined as a painful, palpable, or percussable bladder, when the patient is unable to pass any urine. Chronic retention of urine it is defined as a non-painful bladder, which remains palpable or percussable after the patient has passed urine; such patient may be incontinent.

Controversy

Retention episodes can be divided by any or all of the following: 1) ability of patient to release any urine (complete or partial); 2) duration (acute or chronic); 3) symptoms (painful or silent); 4) mechanism (obstructive or non-obstructive); 5) urodynamic findings (high or low pressure). These two groups also tended to have different symptoms, the low-pressure group complaining of hesitancy, slow stream, and a feeling of incomplete emptying, while the high pressure group also complained of urgency. An association between upper urinary tract dilatation and high pressure CUR was noted (6, 11). Future definitions could consider these parameters.

Current definitions do not included and objective volume. Some investigators have defined CUR as a PVR of > 300 mL (3), others have defined it as > 400 mL (4), or have given it no definite number at all (5, 6). There is no consistent evidence that PVR is directly related to the degree of bother (7). PVR increases with age (8). There is a marked intra-individual variability of PVR (9).

The fine threshold between elevated PVR and CUR is unclear and is not necessarily linked to the presence of complications; the lack of a good definition of CUR makes epidemiological studies impossible. From a clinical standpoint, we need to understand which patients may benefit from relief of BOO and clinical studies suggest that an elevated PVR with a weak detrusor is associated with an increased risk of poor outcome after surgery.

What we really need is a clinical translation of ‘bladder decompensation', that is a measure in terms of muscle contractility. In patients with an elevated PVR, the clinical question is whether the detrusor muscle still functions or not. In cases of good contractility, surgery will restore normal voiding dynamics (6, 11), in cases of a very week detrusor relief of BOO may not improve voiding function (10).
A good change in the definition involves recognition that acute retention is not always painful.

In certain circumstances pain may not be a presenting feature, for example when due to prolapsed intervertebral disc, post partum, or after regional anaesthesia such as an epidural anaesthetic.

References

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21:5–26

  2. Abrams P , Cardozo L , Fall M et al ., Standardisation Sub-committee of the International Continence Society . The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002 ; 21 : 167 – 78

  3. Kaplan SA , Wein AJ , Staskin DR , Roehrborn CG , Steers WD . Urinary retention and post-void residual urine in men: separating truth from tradition . J Urol 2008; 180: 47 – 54

  4. Ghalayini IF , Al-Ghazo MA , Pickard RS . A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention . BJU Int 2005; 96: 93 – 7

  5. Thomas AW , Cannon A , Bartlett E , Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up . BJU Int 2004; 93: 745 – 50

  6. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity. BJU Int 2005; 96: 1295–300

  7. Negro C. L.A., Muir G. H.: Chronic urinary retention in men: How we define it, and how does it affect treatment outcome. BJU Int 2012; 110: 1590 – 1594

  8. Rule AD, Jacobson DJ, McGree ME, Girman CJ, Lieber MM, Jacobsen SJ. Longitudinal changes in post-void residual and voided volume among community dwelling men . J Urol 2005; 174: 1317 – 22

  9. Dunsmuir WD, Feneley M, Corry DA, Bryan J, Kirby RS. The day-to-day variation (test-retest reliability) of residual urine measurement . Br J Urol 1996; 77: 192 – 3

  10. Tubaro A. Editorial comment to Negro C. L.A., Muir G. H.: Chronic urinary retention in men: How we define it, and how does it affect treatment outcome. BJU Int 2012; 110: 1590 – 1594

  11. O’ Reilly PH, Brooman PJ, Farah NB, Mason GC. High pressure chronic retention. Incidence, aetiology and sinister implications . B r J Urol 1986; 58: 644 – 6

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