Initial Management of Acute Urinary Retention

Assessment and Diagnosis

Patients with urinary symptoms should undergo assessment for urinary retention through bladder scanning or straight catheterization, as recommended by the American Heart Association, to determine the presence of urinary retention 3, 4

The initial management for a patient with acute urinary retention should include bladder decompression via catheterization, with an alpha blocker prescribed prior to attempting catheter removal, according to the American Urological Association 1, 2
Perform urethral catheterization for immediate relief of retention, as suggested by the American Urological Association 1, 5
Prescribe an oral alpha blocker prior to attempting catheter removal, which has been shown to improve the chances of successful voiding after catheter removal, with success rates of 60% versus 39% for placebo with alfuzosin, and 47% versus 29% for placebo with tamsulosin 1, 2

Patients who successfully void after catheter removal should be informed that they remain at increased risk for recurrent urinary retention, as stated by the American Urological Association 1
For patients with BPH-related retention who fail TWOC, surgical intervention may be necessary, according to the American Urological Association 5
In patients with stroke who have urinary retention, intermittent catheterization is generally recommended for initial management rather than indwelling catheters, as recommended by the American Heart Association 3, 4, 6
Indwelling catheters should be avoided when possible and removed as soon as the patient is medically and neurologically stable, as suggested by the American Heart Association 7

Prolonged use of indwelling catheters increases the risk of urinary tract infections, as reported by the American Heart Association 6, 7
Not informing patients about the risk of recurrent retention after successful TWOC, as recommended by the American Urological Association 1