Acute Retention of Urine

Common Causes

• Males: Prostatic hypertrophy (Benign and malignant) Preceding symptoms of prostatism Findings on rectal examination Acute urethritis/cystitis can present as acute retention due to mucosal edema
• Drugs: Atropine derivatives, drugs with anticholinergic properties, tricyclic antidepressants, etc. (be cautious while prescribing such drugs to those with altered urinary stream/prostatism)
• Neurogenic causes:

1. Initial symptom of polyradiculopathy like Landry Guillain-Barré syndrome can be acute retention.
2. Radiculopathy involving S 2,3,4 segments due to any cause including vertebral problems, disc prolapse, arachnoiditis or tumors of the region can present as acute retention
3. Hemiplegia and paraplegia due to any cause may be associated with acute retention
4. Autonomic dysfunctions of the bladder like diabetic neuropathy
5. Impacted fecal mass: Many patients are relieved of retention after an enema. Avoid constipation in patients with altered urinary stream including pregnant women.

Note: Patients with acute retention may present in uremic state. It may be associated with UTI and septicemia. After relieving the obstruction there can be a state of post-obstructive diuresis, due to a defect in concentrating mechanism resulting in dehydration and hypokalemia and if fluid replacement is done with salt free fluids, hyponatremia also can occur