Acute urinary retention after urological procedures

Definition

Acute urinary retention (AUR) is a common complication after transurethral, open, and endoscopic surgery.

Causes:

• Tissue edema.
• Sphincter spasm.
• Clot retention.
• Infection.
• Pain.
• Medications.

Clinical assessment

• Inability to void after surgery.
• The catheter has been removed or was not inserted.
• Lower abdominal pain.
• A distended bladder on percussion or ultrasonography.

Diagnosis

• Examination, palpation, percussion.
• Ultrasonography to assess bladder urine volume.
• Catheter irrigation if clot retention is suspected.

Emergency management

• Bladder catheterization (or cystostomy if catheterization is impossible).
• Clot retention: three-way catheter and irrigation.
• Sphincter spasm: alpha-blockers and antispasmodics.
• Postoperative prevention: maintain the catheter until stabilization, early mobilization, alpha-blockers.

Algorithm