What are the causes and treatments of urinary retention in men and women?

From the Guidelines

Urinary retention is more common in men than women, primarily due to benign prostatic hyperplasia (BPH) in men. The causes and treatments of urinary retention vary between men and women. In men, BPH is the most common cause, where an enlarged prostate obstructs urine flow. Treatment options include alpha-blockers like tamsulosin (0.4mg daily) or alfuzosin (10mg daily), which relax prostate muscles, or 5-alpha-reductase inhibitors such as finasteride (5mg daily) that shrink the prostate over 3-6 months 1. For acute retention, catheterization is necessary, while severe cases may require surgical interventions like transurethral resection of the prostate (TURP).

In women, urinary retention often results from pelvic organ prolapse, urethral strictures, or neurological conditions. Treatment may include pelvic floor physical therapy, self-catheterization, or surgical correction of anatomical issues. Both genders can experience retention from medications (particularly anticholinergics, opioids, and certain antidepressants), neurological disorders like multiple sclerosis or diabetes, or after surgery. Management includes addressing the underlying cause, avoiding bladder irritants like caffeine and alcohol, double voiding techniques (urinating, waiting a few minutes, then trying again), and timed voiding schedules.

Some key points to consider in the management of urinary retention include:

• The use of alpha-blockers prior to a voiding trial to treat patients with acute urinary retention related to BPH 1.
• The importance of assessing the risk of urinary retention preoperatively in patients undergoing elective rectal/pelvic surgery 1.
• The recommendation for early removal of the bladder catheter after pelvic surgery with a low estimated risk of postoperative urinary retention 1.
• The use of intermittent catheterization for initial management of urinary retention in patients with stroke 1.

Patients should seek immediate medical attention for sudden inability to urinate, severe lower abdominal pain, or signs of infection like fever with urinary symptoms, as untreated retention can lead to kidney damage, urinary tract infections, or bladder damage.

From the FDA Drug Label

The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies. In A Long-Term Efficacy and Safety Study, efficacy was also assessed by evaluating treatment failures Treatment failure was prospectively defined as BPH-related urological events or clinical deterioration, lack of improvement and/or the need for alternative therapy. BPH-related urological events were defined as urological surgical intervention and acute urinary retention requiring catheterization.

The FDA drug label does not answer the question of whether urinary retention is more common in men or women. The provided drug labels discuss the treatment of benign prostatic hyperplasia (BPH) in men, but do not provide a direct comparison of urinary retention rates between men and women 2, 2.

From the Research

Urinary Retention in Men and Women

• Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine, and it predominantly affects men 3.
• The most common causes of urinary retention are obstructive in nature, with benign prostatic hyperplasia accounting for 53% of cases 3.
• Acute urinary retention (AUR) is more than ten times more common in men than women, and it tends to occur in elderly men, with the risk of AUR being higher in men over 70 years 4.

Causes of Urinary Retention

• The causes of urinary retention in men can be divided into precipitated or occurring spontaneously, and can be further divided according to the mechanism, including obstructive, neurological, and myogenic 4.
• Spontaneous AUR, caused by the progression of BPH leading to a mechanical obstruction of the bladder outlet, is the most common cause of AUR 4.
• Infectious, inflammatory, iatrogenic, and neurologic causes can also affect urinary retention 3.

Treatments of Urinary Retention

• Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization 3.
• Alpha-blockers, such as alfuzosin, can effectively reduce the symptoms associated with BPH and improve the urodynamic parameters of obstruction, and may diminish the incidence of AUR and the need for surgical intervention in symptomatic men 5, 6.
• Silodosin, a novel alpha-blocker, is highly selective for the α1A subtype and provides rapid improvements in the signs and symptoms of moderate to severe LUTS/BPH in male patients, with a favorable tolerability profile 7.

Diagnosis and Evaluation

• Initial evaluation should involve a detailed history that includes information about current prescription medications and use of over-the-counter medications and herbal supplements 3.
• A focused physical examination with neurologic evaluation should be performed, and diagnostic testing should include measurement of postvoid residual (PVR) volume of urine 3.
• Urinalysis and culture should be carried out on a sample obtained after catheterization to rule out infection, and renal function should be assessed to see if there has been damage to the upper tracts 4.