What procedures can help with urinary retention?

From the Guidelines

Clean intermittent catheterization (CIC) is the most effective procedure for managing urinary retention, as it reduces the risk of catheter-associated urinary tract infections and promotes greater independence among patients with bladder emptying problems. Several procedures can help with urinary retention, including:

• Clean intermittent catheterization (CIC): This involves inserting a thin tube into the bladder to drain urine several times a day, using sterile technique and performing 4-6 times daily or as directed by your doctor 1.
• Sacral neuromodulation: A small device is surgically implanted to stimulate the sacral nerves that control bladder function, which can improve retention in some patients.
• Botox injections: Botulinum toxin is injected into the bladder muscle to reduce overactivity and improve emptying, with treatments typically given every 6-12 months.
• Urethral dilation: For urethral strictures, the urethra can be widened using dilators or balloon dilation, which may need to be repeated periodically.
• Transurethral resection of the prostate (TURP): For men with enlarged prostates causing retention, removing prostate tissue can improve urine flow.

Before pursuing procedures, trying behavioral techniques like double voiding, scheduled voiding, and pelvic floor exercises can be beneficial. Medications such as alpha-blockers or 5-alpha reductase inhibitors may also help in some cases 1. The choice of procedure depends on the underlying cause of retention, with neurological issues often responding well to CIC or sacral neuromodulation, and anatomical obstructions may require surgical correction. According to the most recent guidelines, intermittent catheterization is generally recommended for initial management of urinary retention 1.

In terms of catheter materials and methods, hydrophilic and gel reservoir catheters are commonly used for intermittent self-catheterization, although the best approach remains uncertain 1. However, the most recent study on this topic is from 2013, and more recent guidelines recommend intermittent catheterization as the initial management for urinary retention 1.

It is essential to consult a urologist to determine the most appropriate option for your specific situation, as the choice of procedure depends on the underlying cause of retention. The American Heart Association/American Stroke Association recommends screening for urinary retention via bladder scan or straight catheterization in patients with stroke, and treating those found to have urinary retention with intermittent catheterization 1.

From the FDA Drug Label

The symptoms associated with benign prostatic hyperplasia (BPH) are related to bladder outlet obstruction, which is comprised of two underlying components: static and dynamic. The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck leading to constriction of the bladder outlet Blockade of these adrenoceptors can cause smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH

Procedures to help with urinary retention include:

• Relaxation of smooth muscles in the bladder neck and prostate using alpha 1 adrenoceptor blocking agents like tamsulosin, which can improve urine flow rate and reduce symptoms of BPH 2 Note that the FDA label does not explicitly mention "urinary retention" but rather "symptoms of BPH" which can include urinary retention.

From the Research

Procedures for Urinary Retention

The following procedures can help with urinary retention:

• Bladder catheterization with prompt and complete decompression 3
• Suprapubic catheterization, which may be superior to urethral catheterization for short-term management 3
• Use of silver alloy-impregnated urethral catheters to reduce urinary tract infection 3
• Clean, intermittent self-catheterization for patients with chronic urinary retention from neurogenic bladder 3
• Use of low-friction catheters, which have shown benefit in patients with chronic urinary retention from neurogenic bladder 3
• Alpha-blocker therapy, which can increase the success rates of trial without catheter (TWOC) and reduce the incidence of recurrent urinary retention 4, 5, 6
• Double dose alpha-blocker treatment, which may be superior to single dose treatment in managing patients with acute urinary retention caused by benign prostatic hyperplasia 4

Alpha-Blocker Therapy

Alpha-blocker therapy can be used to treat acute urinary retention, and the following alpha blockers have been studied:

• Tamsulosin, which has been shown to be effective in increasing the success rates of TWOC and reducing the incidence of recurrent urinary retention 5, 6, 7
• Alfuzosin, which has also been shown to be effective in increasing the success rates of TWOC and reducing the incidence of recurrent urinary retention 5, 6
• Silodosin, which has been shown to be effective in increasing the success rates of TWOC and reducing the incidence of recurrent urinary retention 5
• Doxazosin, which has been studied but the evidence is limited 5

Other Considerations

The choice of procedure and treatment will depend on the underlying cause of the urinary retention and the individual patient's needs. It is essential to determine the cause of urinary retention through a thorough history, physical examination, and selected diagnostic testing 3.