NICE CG97: Lower urinary tract symptoms in men: management
Urinary retention is the inability to voluntarily urinate. It may be secondary to urethral blockage, drug treatment (such as use of antimuscarinic drugs, sympathomimetics, tricyclic andtidepressants), conditions that reduce detrusor contractions or interfere with relaxation of the urethra, neurogenic causes, or it may occur postpartum or postoperatively.
Acute urinary retention is a medical emergency characterised by the abrupt development of the inability to pass urine (over a period of hours). Chronic urinary retention is the gradual (over months of years) development of the inability to empty the bladder completely, characterised by a residual volume greater than one litre or associated with the presence of a distended or palpable bladder.
The most common cause of urinary retention in men is benign prostatic hyperplasia. Men with an enlarged prostate can have lower urinary tract symptoms associated with obstruction, such as urinary retention (acute or chronic), frequency, urgency or nocturia.
Acute urinary retention is painful and requires immediate treatment by catheterisation. Before the catheter is removed and alpha-blocker should be given for at least two days to manage acute urinary retention.
In male patients with chronic urinary retention whose symptoms are bothersome, drug treatment should only be offered when other conservative management options have failed. Men with moderate to severe symptoms should be offered an alpha-blocker. Treatment should initially be reviewed after 4-6 weeks and then every 6-12 months.