Acute urinary retention refers to the sudden inability to pass urine. It will often be unexpected, usually inconvenient, and always painful. If a man lives long enough his risk of having an episode of acute urinary retention is remarkably high. Over 1 in 10 men in their 70s will experience acute urinary retention within the next five years.1 The risk for men in their 80s is nearly 1 in 3.
Treatment depends largely on where the episode occurred. In some areas men have catheters inserted by their general practitioners (with immediate relief of pain), in others patients have to get to hospital first.2 Once a catheter is inserted treatment depends on local policy. Some men will be sent home with a catheter and collection bag, others will spend a night or two in hospital, and a few will find themselves consenting to prostatectomy the next day.3 Those sent home will have to wait to be readmitted for a trial without catheter or prostatectomy, or both (if the trial fails).
Our understanding of why men develop acute urinary retention has been limited. Until recently, the only way to deal with the condition was to drain the bladder with a catheter. Over the centuries only the materials, silicone rubber instead of silver and ivory, have changed (fig (fig1).1). However, recent developments offer hope of better treatment. Firstly, high quality experimental and community based studies have greatly improved our understanding of the epidemiology and pathogenesis of acute urinary retention. Secondly, recent reports suggest that acute urinary retention might be preventable in some men. Thirdly, development in catheter technology might substantially improve management and make hospital admission unnecessary.
- A man in his 70s has a 1 in 10 chance of experiencing acute urinary retention within 5 years
- Men with urinary symptoms, big prostates, and poor urinary flows are at greater risk
- Many episodes are precipitated by operations performed under general anaesthetic
- Acute urinary retention results in a prostatectomy in about half of men
- Finasteride can halve the risk of acute urinary retention over three years compared with placebo
- New catheters are being developed that could allow outpatient treatment and reduce the need for prostatectomy