Acute urinary retention

Patients may or may not be in acute distress. In early stages of disease, the patient may complain of obstructive voiding symptoms. If untreated, in late stages of disease the patient may complain of irritative voiding symptoms, or acute urinary retention, which is painful due to maximal distention of the urinary bladder. Also, the patient may be symptomatic of disease complications, including urosepsis, pyelonephritis, cystitis, or overflow urinary incontinence. 

Lower abdominal fullness, hesitancy, straining to void, decreased force of stream, interrupted stream, sense of incomplete bladder emptying. May have urinary frequency and urgency, too. Abdominal pain if acute urinary retention is also present. 

Benign prostatic hyperplasia (BPH) (Prascar on/yj.Treatment of symptomatic BPH in men with an enlarged prostate to improve symptoms, reduce acute urinary retention risk, and reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy. 

Adverse reactions may include abdominal pain, abnormal involuntary movements, abnormal liver function tests, aching joints or muscles, acute urinary retention, adenopathy or lymphadenopathy, aggravation of coronary artery disease, aggravation of disseminated lupus erythematosus, agranulocytosis, albuminuria, alopecia, alterations in pigmentation, anorexia, aplastic anemia, arrhythmias, asthma, AV P.729... 

Finasteride was developed as the first orally active, specific inhibitor of 5a-reductase for clinical use. Clinical studies in men with BPH demonstrated that treatment with finasteride reduced prostate size, improved urinary symptoms, and reduced the risk of developing serious BPH-related outcomes, including acute urinary retention (AUR) and the need for surgery, confirming the effects of DHT on the prostate. Additional studies also demonstrated that finasteride is an effective treatment in men with AGA. Several small studies have also suggested it is moderately efficacious in women with hirsutism. A number of other inhibitors of 5a-reductase are also presently in development for the treatment of BPH and AGA. 

Adverse effects Severe respiratory depression occurs. Other effects include vomiting, dysphoria, and allergy-enhanced hypotensive effects (Figure 14.4). The elevation of intracranial pressure, particularly in head injury, can be serious. Morphine enhances cerebral and spinal ischemia. In prostatic hypertrophy, morphine may cause acute urinary retention. A serious action is stoppage of... 

Inman DS, Greene D. The agony and the ecstasy acute urinary retention after MDMA abuse. BJU Int 2003 91 123. 

The unwanted peripheral effects of all atropine-like drugs include flushing of the skin, dryness of the mucous membranes with fever, tachycardia, reduced salivary secretion and dryness of the mouth, drying up of the gastrointestinal secretions and decreased gastric acidity, and reduced muscle tone in the gut and constipation. Bladder tone and frequency of micturition are reduced and acute urinary retention is a risk, especially in older men with prostatic hyperplasia. Nasal, bronchial, and lacrimal secretions are reduced. 

Gruenenfelder J, McGuire EJ, Faerber GJ. Acute urinary retention associated with the use of cyclooxygenase-2 inhibitors. J Urol 2002 168(3) 1106. 

Through its anticholinergic effects disopyramide causes dry mouth and blurred vision and can occasionally cause serious adverse effects, including glaucoma and acute urinary retention (1). 

Flecainide can cause acute urinary retention, perhaps due to a local anesthetic effect on the bladder mucosa (46). 

Ziegelbaum M, Lever H. Acute urinary retention associated with flecainide. Cleve Clin J Med 1990 57(l) 86-7. 

Excessive diuresis and dehydration often cause a transient reduction in glomerular filtration rate and a rise in serum urea (about 8% of all adverse reactions) (SED-8, 350). The sudden diuresis can cause loin pain, particularly in elderly patients, and acute urinary retention and overflow incontinence in elderly men with prostatic hyperplasia. 

McConnell JD, Bruskewitz R, Walsh P, 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. N Engl J Med 1998 338 557-563. 

The metabolic clearance rate of PSA follows a two-compartment model with initial half-lives of 1.2 and 0.75 hours for free PSA and total PSA and subsequent half-lives of 22 and 33 hours. Because of this relatively long half-life, 2 to 3 weeks may be necessary for the serum PSA to return to baseline levels after certain procedures, including transrectal biopsy, transrectal ultrasonography, transurethral resection of the prostate, and radical prostatectomy. Prostatitis and acute urinary retention can also elevate PSA concentration. Although the digital rectal examination has no clinically important effects on serum PSA levels in most patients, in some it may lead to a twofold elevation. 

Marberger MJ, Andersen JT, Nickel JC, et al. Prostate volume and serum prostate specific antigen as predictors of acute urinary retention. Combined experience from three large multicenter national placebo-controlled trials. Eur Urol 2000 38 563-568. 

Andersen JT, Nickel JC, Marshall VR, et al. Finasteride significantly reduces acute urinary retention and need for surgery in patients wifii symptomatic benign prostatic hyperplasia. Urology 1997 49 839-845. 

Digital rectal exam or transrectal ultrasound to rule out prostatic enlargement. Renal function tests to rule out renal failure due to acute urinary retention. 

Morphine causes oliguria, and this results from (1) pronounced diaphoresis (2) the relative hypotension and decreased glomerular filtration rate and (3) the release of antidiuretic hormone from the neurohypophysis. In an elderly patient with prostatic hypertrophy, morphine may cause acute urinary retention. Morphine may reduce the effectiveness of a diuretic when both drugs are used in combination in the treatment of CHF. 

Additional adverse reactions have been reported to include vertigo, nausea, and vomiting experienced by a 37-year-old man who drank several cups of "strong" kava tea (Perez and Holmes 2005) choreoathetosis in a 27-year-old man after occasions of consumption of "large quantities" of kava beverage (Spillane et al. 1997) acute urinary retention in a 61-year-old man who drank 1 liter of kava beverage (Leung 2004) and a case of "intoxication" in a 34-year-old man who drank up to 40 bowls of kava per day (Chanwai 2000). 

Leung, N. 2004. Acute urinary retention secondary to kava ingestion. Emerg. Med. Australas. 16(1) 94. 

Because of its length, the male urethra is vulnerable to traumatic lesions that may cause acute urinary retention and sudden onset of urethrorrhagia and even late stenosis. Urethral trauma can be divided into external trauma, either contusive or penetrative, and internal or endourethral trauma. Internal traumas usually follow iatrogenic maneuvers. External traumas are frequent events and can occur in the penile urethra as a result of road or work accidents, sporting activities or sex. The urethra can be compressed by subcutaneous or intraspongiosal hematomas and may present complete or incomplete mucosal interruption. 

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