Fortnightly review: Acute urinary retention in men: an age old problem

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.3Those 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 (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. #### Summary points