What are the treatment options for urinary retention?

From the Guidelines

Treatment for urinary retention should prioritize catheterization as the first-line treatment, followed by the use of alpha-blocker medications and 5-alpha reductase inhibitors for long-term management, as recommended by the most recent guidelines 1. The treatment options for urinary retention can be categorized into immediate relief measures and long-term management strategies.

• For acute urinary retention, catheterization is the first-line treatment, typically using a Foley catheter (14-16 French) to drain the bladder.
• Alpha-blocker medications like tamsulosin (0.4 mg daily), alfuzosin (10 mg daily), or silodosin (8 mg daily) are often prescribed to relax the prostate and bladder neck muscles, improving urine flow, as supported by recent studies 1.
• For retention caused by benign prostatic hyperplasia (BPH), 5-alpha reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) may be added to reduce prostate size over several months, as recommended by guidelines 1.
• Anticholinergic medications should be discontinued if they're contributing to retention.
• For neurogenic causes, clean intermittent catheterization (CIC) performed 4-6 times daily is often recommended.
• Surgical interventions include transurethral resection of the prostate (TURP) for BPH, urethral stricture repair, or bladder outlet procedures depending on the underlying cause, as stated in surgical guidelines 1.
• Patients should increase fluid intake to 2-3 liters daily unless contraindicated, avoid alcohol and caffeine which can worsen symptoms, and practice timed voiding. The choice of treatment depends on whether the retention is acute or chronic, the underlying cause, and patient-specific factors such as age and comorbidities, emphasizing the need for personalized care 1.

From the FDA Drug Label

The primary endpoint was a composite measure of the first occurrence of any of the following five outcomes: a ≥4 point confirmed increase from baseline in symptom score, acute urinary retention, BPH-related renal insufficiency (creatinine rise), recurrent urinary tract infections or urosepsis, or incontinence Compared to placebo, treatment with finasteride tablets, doxazosin, or combination therapy resulted in a reduction in the risk of experiencing one of these five outcome events by 34% (p=0.002), 39% (p<0.001), and 67% (p<0.001), respectively. In MTOPS, the risk of developing acute urinary retention was reduced by 67% in patients treated with finasteride tablets compared to patients treated with placebo (0.8% for finasteride tablets and 2. 4% for placebo). The risk of requiring BPH-related invasive therapy was reduced by 64% in patients treated with finasteride tablets compared to patients treated with placebo (2.0% for finasteride tablets and 5.4% for placebo).

Treatment options for urinary retention include:

• Finasteride tablets, which reduce the risk of acute urinary retention by 57% (95% CI: 34 to 72%) 2
• Combination therapy with finasteride tablets and doxazosin, which reduces the risk of acute urinary retention by 67% (p<0.001) 2 Key benefits of finasteride tablets include:
• Reduction in symptom score
• Increased maximum urinary flow rate
• Decreased prostate volume
• Reduced risk of BPH-related urological events, including acute urinary retention and the need for surgery 2 2

From the Research

Treatment Options for Urinary Retention

• Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization 3, 4.
• Suprapubic catheterization may be superior to urethral catheterization for short-term management, and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection 3.
• For men with acute urinary retention from benign prostatic hyperplasia, starting alpha blockers at the time of catheter insertion can increase the chance of returning to normal voiding 3, 5.
• Patients with chronic urinary retention from neurogenic bladder can manage their condition with clean, intermittent self-catheterization, and low-friction catheters have shown benefit in these patients 3.

Medical Treatments

• Alpha blockers can prevent acute urinary retention in symptomatic benign prostatic hyperplasia patients and facilitate catheter removal following episodes of spontaneous acute urinary retention 5.
• 5-alpha reductase inhibitors can reduce the risk of acute urinary retention and benign prostatic hyperplasia-related surgery by decreasing prostate volume and improving lower urinary tract symptoms 6.
• Anticholinergics can be safely combined with alpha blockers in symptomatic benign prostatic hyperplasia patients without increasing the risk of acute urinary retention 5.

Surgical Treatments

• Surgical treatment carries a higher rate of morbidity and mortality in men presenting with acute urinary retention compared to those presenting with symptoms alone 5.
• Urgent prostatic surgery after acute urinary retention is associated with greater morbidity and mortality than delayed prostatectomy, and alpha blockers can help delay surgery and may avoid it altogether in some patients 5.
• Transurethral resection of the prostate (TURP) remains the "gold standard" if a trial without catheter fails, and alternative minimally invasive procedures can be considered in poor-risk patients 5.