From the Guidelines
Acute urinary retention with hematuria is most likely caused by a urinary tract obstruction, infection, or malignancy, and requires immediate urologic evaluation and catheterization to relieve the obstruction, as recommended by the American College of Radiology 1. The causes of hematuria can arise from anywhere along the urinary tract and are generally divided into nephrogenic and urogenic causes, with renal parenchymal disease being the most common benign nephrogenic cause, and urolithiasis, infection, and benign prostatic hypertrophy being common benign urogenic causes 1. Some key factors associated with the development of a urinary malignancy include gross hematuria, male gender, age >35 years, smoking, and occupational exposure to chemicals, and patients with gross hematuria have a high association with malignancy of up to 30% to 40% 1. The initial evaluation of a patient with acute urinary retention and hematuria should include:
- A thorough history and physical examination
- Laboratory tests, such as CBC, coagulation studies, and renal function tests
- Imaging studies, such as ultrasound or CT, to determine the underlying cause of the obstruction and hematuria
- Urine cultures to rule out infection
- Cystoscopy to evaluate the bladder and urethra for any abnormalities The most common causes of acute urinary retention with hematuria include benign prostatic hyperplasia, urethral strictures, bladder stones, trauma, or malignancy, and the definitive treatment depends on the underlying cause, ranging from medical therapy to surgical intervention 1. In terms of management, a 16-18 French Foley catheter should be inserted to drain the bladder, with careful monitoring of output and color, and pain management with NSAIDs or opioids may be appropriate, and if infection is suspected, empiric antibiotics such as ciprofloxacin or ceftriaxone should be started after urine cultures are obtained 1.
From the Research
Causes of Acute Urinary Retention with Hematuria
The causes of acute urinary retention with hematuria (blood in urine) can be varied and multifactorial. Some possible causes include:
- Structural issues, such as prostate enlargement in men 2, 3
- Medication or toxicologic causes 3
- Neurologic causes, such as neurologic disease or spinal cord injury 2, 3
- Infectious causes, such as urinary tract infections 3
- Trauma, including vaginal prolapse in women 2
Common Causes in Different Populations
The common causes of acute urinary retention vary depending on the population:
- In elderly males, prostate enlargement is a common cause 2
- In women, vaginal prolapse and neurologic disease are possible causes 2
- In children and elderly patients, trauma, infection, and neurologic pathology must be ruled out 3
Complications of Acute Urinary Retention
Acute urinary retention can lead to several complications, including: