From the Guidelines
Treatment for urinary retention should prioritize addressing the underlying cause and providing immediate relief, with catheterization being the first step for acute retention, and alpha-blockers like tamsulosin or alfuzosin being first-line medications for benign prostatic hyperplasia (BPH) (1).
Key Considerations
- For acute retention, catheterization is typically done using a Foley catheter (14-16 French) to drain the bladder.
- For BPH, alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily) are recommended, with effects beginning within days (1).
- 5-alpha reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) may be added for long-term management, though they take 3-6 months for full effect.
- For retention caused by neurogenic bladder, clean intermittent catheterization (4-6 times daily) is often recommended, sometimes with anticholinergics like oxybutynin (5 mg 2-3 times daily) to reduce bladder overactivity (1).
Additional Recommendations
- Patients should increase fluid intake (2-3 liters daily) and avoid alcohol and caffeine, which can worsen symptoms.
- Practicing double voiding (urinating, waiting a few minutes, then trying again) can help ensure complete bladder emptying.
- Surgical interventions like transurethral resection of the prostate (TURP) may be necessary for persistent BPH-related retention.
- The choice of catheter material and method for intermittent self-catheterization, such as hydrophilic or gel reservoir catheters, should be based on individual patient needs and preferences (1).
From the FDA Drug Label
Bethanechol Chloride Tablets, USP are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder.
Treatment for Urine Retention: Bethanechol is used to treat nonobstructive urinary retention.
- Key Indications:
- Acute postoperative urinary retention
- Postpartum nonobstructive urinary retention
- Neurogenic atony of the urinary bladder with retention It works by stimulating the parasympathetic nervous system, increasing the tone of the detrusor urinae muscle, and producing a contraction to initiate micturition and empty the bladder 2.
From the Research
Treatment of Urinary Retention
- The treatment of urinary retention involves assessing urethral patency and prompt bladder decompression by catheterization 3, 4.
- Suprapubic catheters may be preferred over urethral catheters for short-term management as they improve patient comfort and decrease bacteriuria and the need for recatheterization 3, 4.
- The use of silver alloy-impregnated or antibiotic-impregnated catheters may reduce urinary tract infections, although the benefit may be clinically insignificant 3, 4.
- For patients with chronic urinary retention due to neurogenic bladder, clean intermittent self-catheterization with low-friction catheters can be an effective management strategy 3.
Management Algorithms
- An algorithm for evaluating and managing urinary retention in adult inpatients has been developed, which includes the use of bladder scanners to diagnose urinary retention and guide catheterization decisions 5.
- The algorithm recommends catheterization for symptomatic patients with a bladder volume of 300 mL or greater, and for asymptomatic patients with a bladder volume of 500 mL or greater 5.
- Intermittent catheterization is preferred over indwelling catheterization for managing lower bladder volumes 5.
Preventing Urinary Retention and Bladder Damage
- Guidelines have been developed to prevent urinary retention and minimize bladder damage during hospital care, which include identifying risk factors for urinary retention, managing patients at risk, and using bladder ultrasonography to reduce the need for indwelling urinary catheters 6.
- The guidelines also emphasize the importance of patient documentation and information, as well as strategies for patients with urinary retention 6.