Background

Documentation for urological supplies requires an understanding of what the supplies are used for and when they are indicated. Discussion of some basics in this area is warranted.

Urinary retention is a condition that may be associated with other health conditions and is characterized by the inability to completely empty the bladder. In men, prostate problems may cause urinary retention and in women a prolapsed bladder or cystocele may lead to inadequate bladder emptying. The categories of urinary retention include acute (or short-term and requiring immediate medical attention) and chronic (or longer term and characterized by inadequate emptying of the bladder through urination).

Acute urinary retention is more commonly seen in 10% of men over 70 years of age and around 30% of men over the age of 80. Risk factors for urinary retention include older age and an enlarged prostate gland in men. Chronic urinary retention is more common in older men, but specific statistics are not readily available.

Acute urinary retention is rarer in women with a prevalence of about 0.003%.

An underactive bladder leads to the inability to contract with enough strength or long enough to empty the bladder adequately. This condition can be caused by neurological problems, such as Parkinson’s disease, multiple sclerosis, Alzheimer’s, stroke, spinal cord or brain injury, Guillain-Barré syndrome, and others. Some medications can lead to urinary retention by interfering with nerve signals to the bladder, urethra, or prostate. These medications include anitdepresseants, anti-histamines and decongestants, antipsychotics, benzodiazepines, calcium channel blockers, non-steroidal anti-inflammatories, opioids, and others.

Temporary urinary retention may be seen following surgery because of a mix of receiving fluids and anesthesia. Surgeries may also cause damage and swelling that may block urine. Weak bladder muscles can be related to age, over-distention, pregnancy/childbirth, and traumas.

What is urinary retention?   How common is urinary retention? What are the risk factors for or causes of urinary retention?

Chronic urinary retention may develop slowly over time leading to several problems. These include the inability to adequately empty the bladder, small/frequent urination, hesitancy or a difficulty in starting the urine stream, urgent sensation of the need to urinate – sometimes with no success, feeling the need to urinate after urination is finished, leaking urine without urge or warning, and lower abdominal discomfort or swelling.

Complications may include urinary tract infection, bladder damage, kidney damage, and urinary incontinence. Bacteria that is normally flushed out when the bladder is emptied completely may be able to multiply and, in some cases, spread to the kidneys, causing damage. If the bladder is stretched too much or for long periods of time, the muscles may become damaged. If the bladder is not completely emptied, overflow incontinence or leaking of urine may occur.

Diagnosis generally includes a medical history that concentrates on lower urinary tract symptoms, surgeries or past use of catheters, prostate issues, pregnancy/childbirth, medications, bowel habits, and others. A physical exam will include the lower abdomen, rectal exam, and neurological evaluation. Women will receive a pelvic exam. Measurement of urine retained in the bladder, known as postvoid residual, may include an ultrasound procedure or the use of a catheter. Imaging may include evaluation of the urinary tract structures, including ultrasound, x-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.

Diagnosis may also include urinalysis for infections, kidney problems, and diabetes. Urodynamic testing may be used to evaluate the flow of urine and proper function of the bladder, sphincters, and urethra. Cytoscopy may be used to evaluate the inside of the urethra and bladder for physical signs of infection, cancers, and structural problems.

Treatments vary according to the diagnoses. Acute urinary retention may involve the use of a catheter to drain the bladder and prevent damage. Chronic urinary retention involves matching a treatment with the cause. Medications, medical procedures, physical therapy, bladder training (timed voiding and taking time to relax muscles), and surgeries may be involved. Treatment may also involve a catheter if the retention becomes severe or is permanent despite other treatments. Catheters may be used as needed to drain the bladder known as intermittent catheter, or longer-term indwelling.

Complications of urinary retention Diagnosis of urinary retention Treatments for urinary retention and incontinence