Urethral catheterization outcomes and complications in acute urinary retention: a systematic review of emergency department studies

Background: Acute urinary retention (AUR) is a common emergency condition managed by immediate urethral catheterization (UC), and data on catheter-related complications is less developed than post-catheter voiding outcomes. This systematic review aims to analyze original studies on outcomes and complications of UC in adults with AUR. Methods: Original studies were identified from PubMed, Web of Science, Scopus, and Embase. Eligible studies included adults with AUR managed with UC in ED or acute-care settings and reporting catheter-related complications, trial without catheter (TWOC), re-catheterization, or related clinical outcomes. Findings were synthesized qualitatively. Results: Eight original studies were included. Most studies focused on TWOC success and predictors rather than direct catheter harms. Reported TWOC success ranged from 28.3% to 68.6%, and improved in some studies with alpha-blocker therapy. Factors associated with better voiding outcomes include lower retained urine volume, smaller prostate size, younger age, and lower intravesical prostatic protrusion. Direct complications were less reported, and one comparative cohort showed higher rates of urinary tract infection (UTI), urethral stricture (US), epididymo-orchitis, and septicemia after UC than suprapubic drainage (SPD). Rapid bladder decompression was not associated with important excess hypotension or severe hematuria. Conclusion: UC effectively relieves AUR, and direct complication outcomes still underreported. Future emergency-based studies should assess catheter-related infective and traumatic complications more systematically alongside TWOC outcomes in practice.