Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Systematic review and meta-analysis on management of acute urinary retention

Prostate Cancer and Prostatic Diseases volume 18, pages 297–302 (2015)Cite this article

Subjects

Abstract

Background:

Acute urinary retention (AUR) is a common urological emergency. In this article, we review the current literature and present a structured summary in management of AUR.

Methods:

A systematic review was conducted using the keywords 'acute AND retention AND urin*' within the title in search engines including Medline, EMBASE and EBM Review. The obtained literature was manually reviewed by the primary author (PDY) and was further refined by confining the subject to management of AUR. Exclusion criteria included paediatric and female population studies, case reports, reviews, surveys, economical assessment and articles on AUR in prostate cancer and post-operative patients.

Results:

Total of 54 articles met our inclusion and exclusion criteria. The trial without catheter (TWOC) post-immediate catheterisation is widely practiced although there remains a significant variability in terms of type and duration of catheterisation required, use of concurrent medical therapy or post-catheterisation management. Our systematic review and subsequent meta-analysis has shown superiority of α1-adrenergic receptor blockers over placebo in achieving successful voiding in patients with AUR. Suprapubic catheter (SPC) is an alternative to urethral catheterisation (indwelling catheter (IDC)) and may provide several advantages. Clean intermittent self-catheterisation may be a safe and useful option for patients with AUR until their definitive management. The overall long-term outcome of in-and-out catheterisation remains promising in selected patients. Surgery is an end point in patients with unsuccessful TWOC as well as in those with significant lower urinary tract symptoms post-successful TWOC.

Conclusions:

We recommend use of α1-adrenergic receptor blockers before TWOC and discourage emergency operative management. Use of SPC over IDC in AUR is debatable. Duration of catheterisation is controversial but <3 days is a safe option in avoiding catheterisation-related complications. Although TURP remains the current gold standard, there has been an emergence of newer operative management utilising laser techniques.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Kalejaiye O, Speakman MJ . Management of acute and chronic retention in men. Eur Urol Suppl 2009; 8: 523–529.

    Article  Google Scholar 

  2. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997; 158: 481–487.

    Article  CAS  PubMed  Google Scholar 

  3. Desgrandchamps F, De La Taille A, Doublet JD . The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia. BJU Int 2006; 97: 727–733.

    Article  PubMed  Google Scholar 

  4. Thomas K, Oades G, Taylor-Hay C, Kirby RS . Acute urinary retention: what is the impact on patients' quality of life? BJU Int 2005; 95: 72–76.

    Article  PubMed  Google Scholar 

  5. Groves HK, Chang D, Palazzi K, Cohen S, Parsons JK . The incidence of acute urinary retention secondary to BPH is increasing among California men. Prostate Cancer Prostatic Dis 2013; 16: 260–265.

    Article  CAS  PubMed  Google Scholar 

  6. Cathcart P, van der Meulen J, Armitage J, Emberton M . Incidence of primary and recurrent acute urinary retention between 1998 and 2003 in England. J Urol 2006; 176: 200–204; discussion 4.

    Article  PubMed  Google Scholar 

  7. Armitage JN, Sibanda N, Cathcart PJ, Emberton M, van der Meulen JH . Mortality in men admitted to hospital with acute urinary retention: database analysis. Br Med J 2007; 335: 1199–1202.

    Article  Google Scholar 

  8. Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. University of Oxford; 2009 (cited 14 April 2014); Available from: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/.

  9. Fitzpatrick JM, Desgrandchamps F, Adjali K, Gomez Guerra L, Hong SJ, El Khalid S et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int 2012; 109: 88–95.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Emberton M, Fitzpatrick JM . The Reten-World survey of the management of acute urinary retention: preliminary results. BJU Int 2008; 101: 27–32.

    Article  PubMed  Google Scholar 

  11. Fitzpatrick JM, Kirby RS . Management of acute urinary retention. BJU Int 2006; 97: 16–20.

    Article  PubMed  Google Scholar 

  12. Park K, Kim SH, Ahn SG, Lee SJ, Ha US, Koh JS et al. Analysis of the treatment of two types of acute urinary retention. Korean J Urol 2012; 53: 843–847.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hallett JM, Stewart GD, McNeill SA . The management of acute urinary retention: treating the curse of the aging male. Curr Bladder Dysfunct Rep 2013; 8: 242–249.

    Article  Google Scholar 

  14. Thomas K, Chow K, Kirby RS . Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis 2004; 7: 32–37.

    Article  CAS  PubMed  Google Scholar 

  15. Manikandan R, Srirangam SJ, O’Reilly PH, Collins GN . Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey. BJU Int 2004; 93: 84–88.

    Article  CAS  PubMed  Google Scholar 

  16. Ku JH, Kim SW, Paick JS . Questionnaire survey of urologists' initial treatment practices for acute urinary retention secondary to benign prostatic hyperplasia in Korea. Urol Int 2006; 76: 314–320.

    Article  PubMed  Google Scholar 

  17. Djavan B, Shariat S, Omar M, Roehrborn C, Marberger M . Does prolonged catheter drainage improve the chance of recovering voluntary voiding after acute urinary retention (AUR). Eur Urol 1998; 33: 110.

    Article  Google Scholar 

  18. Taube M, Gajraj H . Trial without catheter following acute retention of urine. Br J Urol 1989; 63: 180–182.

    Article  CAS  PubMed  Google Scholar 

  19. Teoh JY, Kan CF, Tsui B, Chiu PK, Man CY, Hou SS et al. Ambulatory care program for patients presenting with acute urinary retention secondary to benign prostatic hyperplasia. Int Urol Nephrol 2012; 44: 1593–1599.

    Article  PubMed  Google Scholar 

  20. Horgan AF, Prasad B, Waldron DJ, O'Sullivan DC . Acute urinary retention. Comparison of suprapubic and urethral catheterisation. Br J Urol 1992; 70: 149–151.

    Article  CAS  PubMed  Google Scholar 

  21. Ahluwalia RS, Johal N, Kouriefs C, Kooiman G, Montgomery BS, Plail RO . The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl 2006; 88: 210–213.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Harrison SC, Lawrence WT, Morley R, Pearce I, Taylor J . British Association of Urological Surgeons' suprapubic catheter practice guidelines. BJU Int 2011; 107: 77–85.

    Article  PubMed  Google Scholar 

  23. Patel MI, Watts W, Grant A . The optimal form of urinary drainage after acute retention of urine. BJU Int 2001; 88: 26–29.

    Article  CAS  PubMed  Google Scholar 

  24. Ko YH, Kim JW, Kang SG, Jang HA, Kang SH, Park HS et al. The efficacy of in-and-out catheterization as a way of trial without catheterization strategy for treatment of acute urinary retention induced by benign prostate hyperplasia: variables predicting success outcome. Neurourol Urodyn 2012; 31: 460–464.

    Article  PubMed  Google Scholar 

  25. Wyndaele JJ, Brauner A, Geerlings SE, Bela K, Peter T, Bjerklund-Johanson TE . Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int 2012; 110: E910–E917.

    Article  PubMed  Google Scholar 

  26. Caine M, Raz S, Zeigler M . Adrenergic and cholinergic receptors in the human prostate, prostatic capsule and bladder neck. Br J Urol 1975; 47: 193–202.

    Article  CAS  PubMed  Google Scholar 

  27. Zeif HJ, Subramonian K . Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. Cochrane Database Syst Rev 2009, CD006744.

  28. Kumar S, Tiwari DP, Ganesamoni R, Singh SK . Prospective randomized placebo-controlled study to assess the safety and efficacy of silodosin in the management of acute urinary retention. Urology 2013; 82: 171–175.

    Article  PubMed  Google Scholar 

  29. McNeill SA, Hargreave TB, Roehrborn CG . Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. Urology 2005; 65: 83–89 discussion 9-90.

    Article  CAS  PubMed  Google Scholar 

  30. Lucas MG, Stephenson TP, Nargund V . Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int 2005; 95: 354–357.

    Article  CAS  PubMed  Google Scholar 

  31. Tiong HY, Tibung MJ, Macalalag M, Li MK, Consigliere D . Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia. Urol Int 2009; 83: 44–48.

    Article  CAS  PubMed  Google Scholar 

  32. Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM . Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention. Eur Urol 2002; 42: 329–332; discussion 32.

    Article  CAS  PubMed  Google Scholar 

  33. McNeill SA, Daruwala PD, Mitchell ID, Shearer MG, Hargreave TB . Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled. BJU Int 1999; 84: 622–627.

    Article  CAS  PubMed  Google Scholar 

  34. Maldonado-Avila M, Manzanilla-Garcia HA, Sierra-Ramirez JA, Carrillo-Ruiz JD, Gonzalez-Valle JC, Rosas-Nava E et al. A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth. Int Urol Nephrol 2014; 46: 687–690.

    Article  CAS  PubMed  Google Scholar 

  35. Agrawal MS, Yadav A, Yadav H, Singh AK, Lavania P, Jaiman R . A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia. Indian J Urol 2009; 25: 474–478.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hua LX, Wu HF, Sui YG, Chen SG, Xu ZQ, Zhang W et al. [Tamsulosin in the treatment of benign prostatic hyperplasia patients with acute urinary retention]. Natl J Androl 2003; 9: 510–511.

    Google Scholar 

  37. Al-Hashimi MMR . Alfuzosin 10 mg once daily in the management of acute urinary retention of benign prostatic hyperplasia: a double-blind, placebo-controlled study. Curr Urol 2007; 1: 28–34.

    Article  CAS  Google Scholar 

  38. Prieto L, Romero J, Lopez C, Ortiz M, Pacheco JJ . Efficacy of doxazosin in the treatment of acute urinary retention due to benign prostate hyperplasia. Urol Int 2008; 81: 66–71.

    Article  CAS  PubMed  Google Scholar 

  39. Lorente GJ, Cañis SD, Arango TO, Bielsa GO, Cortadellas AR, Gelabert MA . [Doxazosin in the gastrointestinal therapeutic system (GITS) formulation and trial without catheter after acute urinary retention due to BPH. Dose increase action on recovery effect]. Actas Urol Esp 2004; 28: 32–37.

    Article  Google Scholar 

  40. Perepanova TS, Kamalov AA, Siniukhin VN, Gorokhnov AV, Khazan PL, Orlova EV . [Doksazozin "Cardura" in acute urinary retention caused by benign prostatic hyperplasia]. Urologiia 2001; 3: 18–20. PMID: 11505534.

    Google Scholar 

  41. Marberger MJ . Long-term effects of finasteride in patients with benign prostatic hyperplasia: a double-blind, placebo-controlled, multicenter study. PROWESS Study Group. Urology 1998; 51: 677–686.

    Article  CAS  PubMed  Google Scholar 

  42. Roehrborn CG, Bruskewitz R, Nickel GC, Glickman S, Cox C, Anderson R et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group. Eur Urol 2000; 37: 528–536.

    Article  CAS  PubMed  Google Scholar 

  43. McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998; 338: 557–563.

    Article  CAS  PubMed  Google Scholar 

  44. Flanigan RC, Reda DJ, Wasson JH, Anderson RJ, Abdellatif M, Bruskewitz RC . 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. The Journal of urology. 1998; 160: 12–16; discussion 6-7.

  45. Lo KL, Chan MC, Wong A, Hou SM, Ng CF . Long-term outcome of patients with a successful trial without catheter, after treatment with an alpha-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia. Int Urol Nephrol 2010; 42: 7–12.

    Article  CAS  PubMed  Google Scholar 

  46. Kumar V, Marr C, Bhuvangiri A, Irwin P . A prospective study of conservatively managed acute urinary retention: prostate size matters. BJU Int 2000; 86: 816–819.

    Article  CAS  PubMed  Google Scholar 

  47. Hastie KJ, Dickinson AJ, Ahmad R, Moisey CU . Acute retention of urine: is trial without catheter justified? J R Coll Surg Edinburgh 1990; 35: 225–227.

    CAS  Google Scholar 

  48. Pickard R, Emberton M, Neal DE . The management of men with acute urinary retention. National Prostatectomy Audit Steering Group. Br J Urol 1998; 81: 712–720.

    Article  CAS  PubMed  Google Scholar 

  49. Chacko KN, Donovan JL, Abrams P, Peters TJ, Brookes ST, Thorpe AC et al. Transurethral prostatic resection or laser therapy for men with acute urinary retention: the ClasP randomized trial. J Urol 2001; 166: 166–170 discussion 70-1.

    Article  CAS  PubMed  Google Scholar 

  50. Kabalin JN, Mackey MJ, Cresswell MD, Fraundorfer MR, Gilling PJ . Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention. J Endourol 1997; 11: 291–293.

    Article  CAS  PubMed  Google Scholar 

  51. Zhuo J, Wei HB, Zhao FJ, Sun F, Han BM, Sun XW et al. Two-micrometer thulium laser resection of the prostate-tangerine technique for patients with acute urinary retention. Lasers Med Sci 2013; 29: 1093–1098.

    Article  PubMed  Google Scholar 

  52. Chung A, Woo HH . Photoselective vaporization of the prostate with the 120 W lithium triborate laser for the treatment of acute urinary retention. Prostate 2012; 1050: 58–121.

    Google Scholar 

  53. Fu WJ, Gao JP, Hong BF, Yang Y, Cai W, Zhang L . Photoselective laser vaporization prostatectomy for acute urinary retention in China. J Endourol 2008; 22: 539–543.

    Article  PubMed  Google Scholar 

  54. Elbendary M, El-Gamal O, Soliman M, Tawfik A, Taha M . Role of combined use of ketoconazole and tamsulosin in management of acute urinary retention due to benign prostatic obstruction (a randomized controlled trial). Prostate Cancer Prostatic Dis 2013; 16: 362–366.

    Article  CAS  PubMed  Google Scholar 

  55. Djavan B, Seitz C, Ghawidel K, Basharkhah A, Bursa B, Hruby S et al. High-energy transurethral microwave thermotherapy in patients with acute urinary retention due to benign prostatic hyperplasia. Urology 1999; 54: 18–22.

    Article  CAS  PubMed  Google Scholar 

  56. Kotsar A, Isotalo T, Juuti H, Mikkonen J, Leppiniemi J, Hanninen V et al. Biodegradable braided poly(lactic-co-glycolic acid) urethral stent combined with dutasteride in the treatment of acute urinary retention due to benign prostatic enlargement: a pilot study. BJU Int 2009; 103: 626–629.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga,, New South Wales, Australia

    P D Yoon, V Chalasani & H H Woo

Authors
  1. P D Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V Chalasani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H H Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H H Woo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoon, P., Chalasani, V. & Woo, H. Systematic review and meta-analysis on management of acute urinary retention. Prostate Cancer Prostatic Dis 18, 297–302 (2015). https://doi.org/10.1038/pcan.2015.15

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2015.15

This article is cited by

Search

Advanced search

Quick links