What is the treatment for urinary retention?

From the Guidelines

Treatment for urinary retention typically involves surgical intervention, intermittent self-catheterization, or medical therapy with alpha-blockers.

Treatment Options

• Surgical intervention is an appropriate treatment option for patients with moderate-to-severe lower urinary tract symptoms (LUTS) and for patients who have developed acute urinary retention or other benign prostatic hyperplasia (BPH)-related complications 1.
• Intermittent self-catheterization is a preferred method of catheterization for patients with urinary retention, particularly those with neurogenic bladder or refractory bladder, and can help reduce catheter-associated urinary tract infections (UTIs) and promote greater independence 1.
• Medical therapy with alpha-blockers, such as tamsulosin or alfuzosin, can be used prior to attempted catheter removal in patients with urinary retention, and may be preferable in patients with temporary factors contributing to retention 1.

Important Considerations

• The decision to elect surgery as the treatment option should be based upon the patient’s own views of treatment risks versus benefits 1.
• The choice of catheter material and method for intermittent self-catheterization remains uncertain, with hydrophilic, gel reservoir, and non-coated catheters being available options 1.
• Concomitant administration of an alpha-blocker would not be appropriate in patients with a prior history of alpha-blocker side effects or unstable medical comorbidities 1.

From the Research

Treatment Options for Urinary Retention

The treatment for urinary retention depends on the underlying cause and can be managed through various options, including:

• Bladder catheterization with prompt and complete decompression 2, 3, 4
• Use of alpha blockers, such as alfuzosin and tamsulosin, to improve voiding trials 2, 3, 5
• Suprapubic catheterization, which may be superior to urethral catheterization for short-term management 2, 3
• Clean, intermittent self-catheterization for patients with chronic urinary retention from neurogenic bladder 2
• Surgical treatments, such as Rezūm vapor ablation, for benign prostatic hyperplasia (BPH) 6
• Medical treatments, such as 5-alpha reductase inhibitors, for BPH 6

Management of Urinary Retention

The management of urinary retention involves:

• Assessment of urethral patency with prompt and complete bladder decompression by catheterization 3
• Determining the cause and chronicity of the urinary retention to guide further management 3
• Initiation of alpha blockers with voiding trials for patients with BPH 3, 5
• Monitoring of patients with urinary retention related to an underlying neurologic cause in conjunction with neurology and urology subspecialists 3

Specific Treatments for Benign Prostatic Hyperplasia (BPH)

For patients with BPH, treatment options include:

• Alpha blockers, such as alfuzosin and tamsulosin, to improve voiding trials 5
• Rezūm vapor ablation, a minimally invasive treatment that uses injections of sterile water vapor directly into the prostate for tissue ablation 6
• 5-alpha reductase inhibitors, which can help reduce prostate size and improve symptoms 6