Acute urinary retention: An expert's guide

Written by: Mr Andrew Ballaro
Published: | Updated: 09/08/2023
Edited by: Conor Duneorth

Acute urinary retention is a painful and distressing condition that requires immediate medical attention. In his latest article, consultant urologist Mr Andrew Ballaro explains acute urinary retention in detail, including its causes, treatments and symptoms.


What is acute urinary retention?

Acute urinary retention is the sudden and painful inability to pass urine.


What are the symptoms of acute urinary retention?

The symptoms are the inability to pass urine when you feel the need to, and this is associated with increasing pain in the lower abdomen, distress and anxiety.


What are the common causes of acute urinary retention?

Acute urinary retention can occur in both sexes but is more common in men due to prostate problems. It may be precipitated by factors which increase the resistance of the outflow tract of the bladder, reduce the ability of the bladder to contract, or both. Such events include urinary tract infection, constipation, general or regional anaesthetics, and operations on the urinary tract.


Urinary retention can also be precipitated by drinking excessive amounts of alcohol and prolonged periods of having to hold on to the urine for example during a long journey, which can overstretch the bladder and reduce its ability to push the urine out. Sometimes there is no obvious precipitating cause and it happens out of the blue when it is termed spontaneous. Both spontaneous and precipitated urinary retention are commonly associated with previous symptoms of difficulty passing urine or prostate problems.


How is acute urinary retention treated?

Initial treatment of acute urinary retention involves the insertion of a urinary catheter to drain the urine and enable the bladder to empty. This normally requires attendance to the A+E department. Investigations will be done to try to identify treatable precipitating causes which are then treated, and tablets to relax the prostate are normally started.  Arrangements are then made to remove the catheter and monitor whether the patient can pass urine again. This is called a Trial WithOut Catheter- or TWOC, and normally occurs in a nurse-led dedicated TWOC clinic.


If the patient is able to pass urine when the catheter is removed we usually advise continuing the medication for a few months. If not, the catheter has to be reinserted and the treatment options are then to stay with the catheter, which is suitable for some very elderly or frail patients, be taught self-intermittent self-catheterisation, or most commonly to have an operation on the prostate. Surgical operations work by removing the obstructing part of the prostate gland, and include Transurethral resection of the prostate (TURP), and Holmium Laser enucleation of the prostate (HoLEP).


Will acute urinary retention go away on its own?

Acute urinary retention does not resolve on its own and requires a catheter to be inserted to relieve the blockage and pain. However, after a short period of catheterisation which allows the bladder to recover, about half of patients are able to pass urine again when the catheter is removed. Urinary retention is not helped by drinking more water, and may be a sign of something more serious, so patients should be examined and investigated by a urologist. The condition is an emergency, can be extremely painful and distressful and requires urgent medical care


Mr Andrew Ballaro is a leading consultant urologist based in London and Brentwood. If you would like to book a consultation with Mr Ballaro to discuss any urological concerns you may have, you can do so via his Top Doctors profile.

By Mr Andrew Ballaro

Mr Andrew Ballaro is a highly regarded consultant urologist in North London and Essex with over 15 years of experience. He specialises in the management of all urological problems including blood in urine, urinary infections, prostate pain syndromes, general prostate and bladder disease, and the diagnosis of urological cancers including the investigation of raised PSA with MRI Fusion prostate biopsy.

He has specialist surgical expertise in the management of kidney stone disease and benign prostate enlargement (BPE), and consistently publishes UK leading surgical outcomes for complex stone operations. He offers a choice of surgical procedures for benign prostatic enlargement tailored to the patient’s requirements including Holmium Laser prostatectomy (HOLEP) and is highly experienced in dealing with very large prostates and urinary retention, with every patient in a large series going home the day after surgery without a catheter.

Mr Ballaro takes satisfaction in providing second opinions, and is supported by a warm, skilled and responsive managerial team. Together they aim to provide the best possible outcome for each and every patient. Mr Ballaro's extensive training began after graduating from The Royal Free Hospital Medical School in London, and undertaking his surgical training at Oxford. He was awarded a fellowship from the Royal College of Surgeons of London and went on to complete higher urological training on the North London Training Scheme. This was followed by advanced training in complex stone surgery from national and international experts in his field.

Alongside his dedication to education, he is currently teaching trainees at the London Deanery, catering to various levels of expertise. Additionally, he has been honoured with a Hunterian Professorship from the Royal College of Surgeons of England, showcasing his commitment to scholarly pursuits. Holding a master’s degree in urology and an MD in clinical sciences from the Institute of Urology, Mr. Ballaro has extensively published research on bladder physiology and minimally invasive urological surgery. He is the co-author of the latest edition of the popular medical student textbook 'Lecture Notes in Urology'.


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