Urology Conditions
      Back to home
      1. VCT Resource Library
      2. Urology Conditions

      Chronic Urinary Retention

      Condition: Chronic Urinary Retention

      Brief Overview: According to UpToDate, “Chronic urinary retention (CUR) is the accumulation of urine in the bladder that results from incomplete or inadequate bladder emptying. Incomplete bladder emptying is most commonly described and measured as the volume of urine left in the bladder after voiding, also known as the postvoid residual. High-risk CUR results in adverse outcomes in the absence of intervention, while patients with asymptomatic low-risk CUR can often be observed. CUR is diagnosed by confirming an elevated postvoid residual (PVR) urine volume with a bladder catheter or ultrasound. A PVR of more than 100 mL is commonly used to describe incomplete bladder emptying, while the American Urological Association (AUA) Quality Improvement and Patient Safety committee defines CUR as a PVR of more than 300 mL that has persisted for at least six months.”

      Prevalence: The exact prevalence is unknown.

      Etiology:

      • Obstructive causes
        • Benign prostatic hyperplasia (BPH)
        • Urethral stricture
        • Bladder outlet obstruction
        • Ureteral obstruction
        • Bladder or pelvic masses
        • Pelvic organ prolapse (women)
      • Neurogenic causes
        • Spinal cord injury, multiple sclerosis, diabetic neuropathy
        • Parkinson’s disease, stroke
        • Detrusor underactivity
      • Medication-induced causes
        • SOME anticholinergics, antihistamines, opioids, tricyclic antidepressants, antipsychotics, muscle relaxers, antihypertensives
      • Functional causes
        • Detrusor-sphincter dyssynergia
        • Post-surgical urinary retention
      • Infectious/edematous
        • UTIs
        • STIs
        • Prostatitis

      Risk Factors:

      • Increasing age
      • Male > female
      • BPH in males
      • Neurogenic disease – Parkinson’s, MS
      • Urethral mass
      • Previous surgery for incontinence
      • Pelvic organ prolapse (POP)
      • Prior pelvic surgery or radiation

      Commonly Associated Conditions:

      • BPH
      • Pelvic organ prolapse, cystocele
      • Neurogenic bladder
      • Recurrent UTIs

      Common Medications:

      • Antibiotics
      • Alpha-blockers
      • 5-alpha-reductase inhibitors

      Common Labs, Imaging, and Tests:

      • Post-void residual (PVR)
      • Urodynamic testing
      • Cystoscopy
      • Ultrasound, MRI, CT
      • Voiding cystourethrogram
      • Urinalysis, urine culture
      • Blood tests to check kidney function

      Common Symptoms:

      • Can be asymptomatic in some cases
      • Incomplete emptying
      • Urinary frequency
      • Urinary hesitancy
      • Urinary urgency
      • Urinary incontinence
      • Nocturia
      • Weak urine stream

      Common Treatments:

      • Pelvic floor physical therapy
      • Bladder training
      • Catheterization
      • Surgery may be indicated

      Physical Findings:

      • Palpable distended bladder on abdominal exam
      • Dullness to percussion over the suprapubic area
      • Enlarged prostate on DRE (if BPH)
      • Pelvic organ prolapse in women

      Potential Complications and Contraindications:

      • UTIs
      • Bladder damage
      • Bladder stones
      • Kidney damage
      • Urinary incontinence

      General Health and Lifestyle Guidance:

      • Scheduled voiding and bladder training if appropriate (discuss with your healthcare provider).
      • Address constipation to reduce bladder outlet pressure.
      • Avoid medications that exacerbate retention (e.g., antihistamines, anticholinergics, opioids) if possible. Always discuss with your healthcare provider first before making any medication changes or stopping medications.
      • Hydration: maintain balanced fluid intake. Ask your healthcare provider if you have any fluid intake recommendations/restrictions.
      • Catheter care education if intermittent or chronic catheter use is required.
      • Encourage regular follow-up with urology to monitor renal function and bladder health.
      • Education on early UTI signs for prompt treatment.

      Suggested Questions to Ask Patients:

      • How long have you been experiencing difficulty emptying your bladder?
      • Do you have urinary urgency, weak stream, or leakage?
      • Have you ever required catheterization?
      • Are you currently taking any medications for BPH or bladder function?
      • Have you had recurrent urinary tract infections?
      • Have you experienced any flank pain or signs of kidney problems?
      • Do you have any neurological conditions (e.g., MS, spinal cord injury, diabetes)?

      Suggested Talking Points:

      • Chronic urinary retention can often be managed effectively with medications, lifestyle strategies, or procedures depending on the cause.
      • It’s important to monitor kidney function and to try to prevent complications like infections or stones.
      • Regular follow-up with your urologist is key to trying to preventing long-term problems.
      • You may need to avoid certain medications to help prevent worsening of symptoms.
      • Catheter use, if needed, can be managed safely with proper care and monitoring.
      • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

      Sources:

      This resource is for educational purposes only and is not a substitute for professional medical advice. The patient should always follow your healthcare provider’s instructions.

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner