Definition & Causes
This is a sudden painful inability to pass urine due to various underlying causes.
The common cause for the retention in males is the obstruction (blockage) caused by the prostate which could be due to enlarged benign enlargement of the prostate which is age related or possibly cancer. Other conditions like prostatitis can also bring on retention of the urine. Apart from this, other conditions such as neurological causes or spinal cord injuries can also cause a retention of urine.
Due to the inability of the bladder to contract and expel urine immediate and initial treatment will be to drain the bladder with a tube called a catheter. This will be usually passed through the urethra into the bladder to decompress the bladder. If there is any difficulty in passing the catheter through the urethra due to any obstruction or stricture in the urethra the catheter may have to be put through the lower abdomen straight in to the bladder which is called supra-pubic catheter.
Trial of Voiding
Before the definite treatment for men who have retention of urine due to obstruction from the prostate the further treatment option would be to give a trial without catheter at least 48 hours after the initial period of catheterisation. During this time if the patient had not been taking any medication for the prostate they would be started on some medication from the group called alpha-blockers. The common medicines in this group are called Tamsulosin or Alfuzocin. This tends to relax the prostate and the bladder neck and increase the chances of successful natural passing of urine once the catheter is removed. If the natural passing of urine is established with a successful trail without catheter then men can continue with that medication. Still there is a higher risk of occurrence of the retention he first year or so.
When the Trial of Voiding fails
If this trial without catheter fails, the following options will be available:-
- Continuing with a long-term catheter if there is any concerns about going for surgery due to age or other medical problems that could increase the risk of operation.
- Doing self-catheterisation which means passing a catheter the patients themselves around 4-5 times per day to empty the bladder.
- Operation to relieve the obstruction at the level of the prostate which could be by Transurethral resection of prostate or Holmium Laser Enucleation of prostate.
The retentions caused by other neurological conditions without any obstruction, the main method of treatment will be to do self-catheterization or long-term catheter.