Treatment of Urinary Retention in Teenagers
The primary treatment for urinary retention in teenagers should focus on urotherapy aimed at optimizing bladder emptying efficiency, including a regular drinking and voiding regimen with attention to proper voiding posture, along with pharmacological therapy such as alpha-blockers when indicated. 1
Initial Assessment
- A thorough history should explore all aspects of urinary retention, including onset, frequency, associated symptoms (dysuria, urgency), and relationship to environmental changes 1, 2
- Physical examination should focus on identifying potential causes including bladder distention, fecal impaction, genital abnormalities, and neurological signs 1
- Urinalysis and possibly urine culture should be obtained to rule out infection as a cause of retention 1, 2
- Assessment of post-void residual urine volume is essential for diagnosis and monitoring treatment response 1, 3
- Evaluate for constipation, as it can cause mechanical pressure on the bladder leading to retention 1, 2
Causes of Urinary Retention in Teenagers
- Dysfunctional voiding with detrusor underactivity, characterized by impaired contractility and incomplete bladder emptying 1
- Neurological conditions affecting bladder function, including rare conditions like acute disseminated encephalomyelitis 4
- Obstruction from anatomical abnormalities or constipation 1
- Medication side effects, particularly from anticholinergics or alpha-adrenergic agonists 5
- Psychological factors, especially in cases following significant stress or trauma 1
Treatment Approach
Non-Pharmacological Interventions
- Urotherapy is the mainstay of treatment, consisting of:
- Regular moderate drinking and voiding schedule 1, 2
- Proper voiding posture to facilitate pelvic floor muscle relaxation 1
- Double voiding technique (several toilet visits in close succession) for those with increased post-void residuals 1
- Addressing concurrent bowel dysfunction, as constipation can exacerbate urinary retention 1, 2
Catheterization
- For acute urinary retention, prompt bladder decompression via catheterization is essential 5, 3
- For chronic retention, clean intermittent self-catheterization may be necessary 5
- Suprapubic catheterization may be superior to urethral catheterization for short-term management in certain cases 5, 3
Pharmacological Treatment
- Alpha-adrenergic blockers (α-blockers) are the primary pharmacological treatment for improving bladder emptying in dysfunctional voiding 1
- For cases with concurrent detrusor overactivity, antimuscarinic medications may be considered, but must be used cautiously as they can worsen retention 1
- Antibiotic prophylaxis may be considered in children with recurrent urinary tract infections until symptoms improve 1
Monitoring and Follow-up
- Regular monitoring with voiding charts, uroflowmetry, and measurement of post-void residuals is essential 1
- Treatment success should be evaluated based on:
Special Considerations
- For teenagers with retention due to neurological causes, coordination with neurology and urology specialists is recommended 3, 4
- In cases where psychological factors contribute to retention, addressing these issues concurrently is important 1, 2
- For retention associated with nocturnal polyuria, waking the teenager to void or using antidiuretic hormone therapy may be considered 1
Common Pitfalls to Avoid
- Failing to screen for and treat constipation, which is a common comorbidity 1, 2
- Overlooking potential neurological causes of urinary retention, especially in previously healthy teenagers 4
- Using anticholinergic medications without careful consideration, as they can worsen retention 1, 5
- Neglecting psychological factors, especially in cases following stressful events 1, 2