Initial Imaging for Urinary Retention in Young Adults

Initial Diagnostic Approach

The American Urological Association recommends transabdominal ultrasonography to measure post-void residual volume and assess for hydronephrosis in patients with urinary retention 1, 2
Ultrasonography allows simultaneous evaluation of prostate shape, size, configuration, and bladder wall thickness, according to the American College of Radiology 2, 3
Ultrasound can detect potential causes of obstruction, including urethral stricture, prostatic enlargement, or bladder abnormalities, as stated by the Journal of Urology 4
Color Doppler assessment can evaluate ureteral jets, bladder distension, and postvoid residual volume, as recommended by the Journal of the American College of Radiology 5

For suspected urethral stricture, retrograde urethrography is the study of choice for delineating stricture length, location, and severity, according to the Journal of Urology 6, 4
Urethrocystoscopy allows direct visualization and localization of urethral strictures, as stated by the Journal of Urology 6, 4
The American Urological Association suggests that urethral stricture should be strongly considered in the differential diagnosis for young men with voiding symptoms 4

Repeat post-void residual measurements to improve precision due to marked intra-individual variability, as recommended by the Journal of Urology 3, 4
Analyze urine flow pattern to suggest obstruction, according to the Journal of Urology 4
The American College of Radiology advises against relying on a single uroflowmetry measurement instead of obtaining at least two measurements 4
Failing to distinguish between detrusor underactivity and obstruction requires pressure-flow studies, as stated by the Journal of Urology 2, 4
The Journal of Urology recommends considering urethral stricture in young men with voiding symptoms 6, 4