From the Guidelines
Management of urinary retention requires prompt intervention with urinary catheterization, typically with a 14-16 French Foley catheter, to immediately decompress the bladder, followed by treatment of the underlying cause, such as benign prostatic hyperplasia (BPH) with alpha-blockers like tamsulosin or alfuzosin, as recommended by the most recent guidelines 1.
Initial Management
The first-line treatment for urinary retention is urinary catheterization to relieve bladder distension. For acute retention, catheterization should be followed by a gradual drainage protocol to prevent hematuria and hypotension from rapid decompression.
- Catheterization should be performed with a 14-16 French Foley catheter.
- Gradual drainage protocol: 500-750 mL initially, then clamping for 15-30 minutes.
Treatment of Underlying Cause
If the cause is BPH, alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily) should be started, as they have been shown to improve symptoms and reduce the risk of recurrent urinary retention 1.
- Alpha-blockers are the first-line treatment for BPH-related urinary retention.
- 5-alpha reductase inhibitors like finasteride (5 mg daily) or dutasteride (0.5 mg daily) may be added for severe cases or when catheter removal fails.
Long-term Management
For retention due to neurogenic causes, clean intermittent catheterization may be necessary long-term, as it has been shown to reduce the risk of urinary tract infections and promote greater independence among patients with bladder emptying problems 1.
- Clean intermittent catheterization is a recommended long-term management option for neurogenic urinary retention.
- Surgical interventions like transurethral resection of the prostate (TURP) are considered when medical management fails or for severe obstruction.
Monitoring and Prevention
Throughout treatment, monitoring for urinary tract infections is essential, with prophylactic antibiotics sometimes indicated for prolonged catheterization, as UTIs are a common complication of urinary catheterization 1.
- Monitoring for UTIs is crucial in patients with urinary catheterization.
- Prophylactic antibiotics may be indicated for prolonged catheterization to prevent UTIs.
From the FDA Drug Label
The results of MTOPS are consistent with the findings of the 4-year, placebo-controlled study A Long-Term Efficacy and Safety Study [see CLINICAL STUDIES (14. 1)] in that treatment with finasteride tablets reduces the risk of acute urinary retention and the need for BPH-related surgery. 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). Compared with placebo, finasteride tablets was associated with a significantly lower risk for acute urinary retention or the need for BPH-related surgery [13.2% for placebo vs 6. 6% for finasteride tablets; 51% reduction in risk, 95% CI: (34 to 63%)]. Compared with placebo, finasteride tablets was associated with a significantly lower risk for surgery [10.1% for placebo vs 4.6% for finasteride tablets; 55% reduction in risk, 95% CI: (37 to 68%)] and with a significantly lower risk of acute urinary retention [6.6% for placebo vs 2. 8% for finasteride tablets; 57% reduction in risk, 95% CI: (34 to 72%)]
The management options for urinary retention include medication such as finasteride tablets, which reduces the risk of acute urinary retention by 57% compared to placebo 2 2.
- Surgery may also be an option for patients with urinary retention, with finasteride tablets reducing the risk of BPH-related surgery by 55% compared to placebo 2.
- Catheterization may be necessary for patients with acute urinary retention requiring catheterization, with finasteride tablets reducing the risk of this event by 57% compared to placebo 2.
From the Research
Management Options for Urinary Retention
The management of urinary retention involves several options, including:
- Initial assessment of urethral patency with prompt and complete bladder decompression by catheterization 3
- Use of alpha blockers to facilitate voiding trials 4, 5, 6
- Trial without catheter (TWOC) after a period of catheterization, with a success rate of around 61% 5
- Surgical treatment, such as transurethral resection of the prostate (TURP), which is considered the "gold standard" if a trial without catheter fails 4
Catheterization Options
Different types of catheterization can be used, including:
- Urethral catheterization, which is the initial management of choice in most cases 4, 5, 6
- Suprapubic catheterization, which can improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term 3
- Intermittent catheterization, which is preferred over indwelling catheterization for managing lower bladder volumes 7
Medical Management
Medical management options include:
- Use of alpha blockers, such as alfuzosin, to prevent acute urinary retention (AUR) in men with benign prostatic hyperplasia (BPH) and to facilitate catheter removal following episodes of spontaneous AUR 4, 5
- Use of 5-alpha-reductase inhibitors to prevent AUR in men with BPH having moderate to severe lower urinary tract symptoms and large prostate size 4
- Anticholinergics, which can be safely combined with alpha blockers in symptomatic BPH patients without increasing the risk of AUR 4
Surgical Management
Surgical management options include: