Optimal Treatment for Urinary Retention

Urinary retention is a disorder of the urinary system that occurs when urine accumulates in the bladder and cannot be normally voided. Patients with urinary retention typically experience lower abdominal distension and pain, and the lower abdomen may appear visibly swollen due to the retained urine. Urinary retention is generally classified as either acute or chronic, and treatment strategies differ accordingly.

Optimal Treatment Approaches for Urinary Retention
　　1. Acute Urinary Retention
　　The primary treatment principle is to eliminate the underlying cause and restore normal urination. If the etiology remains unclear or the obstruction cannot be promptly relieved, immediate bladder decompression should be performed via catheterization or suprapubic cystostomy to alleviate symptoms, followed by further diagnostic evaluation to identify the cause. If urination remains unachievable despite interventions such as suprapubic heat application or acupuncture, urinary catheterization should be performed. For cases where urinary retention persists, an indwelling urinary catheter should be placed for continuous drainage, with subsequent removal based on clinical assessment. In patients with acute urinary retention who cannot undergo standard urethral catheterization, suprapubic bladder puncture and drainage (cystocentesis) is indicated. If a specialized cystocentesis needle is unavailable, surgical suprapubic cystostomy may be performed. When the obstructive cause cannot be resolved definitively, long-term or permanent urinary diversion may be required, with periodic replacement of the cystostomy tube.

When draining urine via urethral catheterization or suprapubic cystostomy in acute urinary retention, urine should be released intermittently and slowly—approximately 500–800 mL per session—to avoid rapid bladder decompression, which may precipitate a sudden drop in intravesical pressure and lead to significant intravesical hemorrhage.
　　2. Chronic Urinary Retention
　　In cases caused by mechanical obstruction associated with upper urinary tract dilation (e.g., hydronephrosis) and impaired renal function, initial bladder drainage is essential. Once hydronephrosis has improved and renal function has stabilized, definitive treatment targeting the underlying obstruction should be undertaken. In contrast, if urinary retention results from functional (neurogenic or dynamic) obstruction, most patients require long-term indwelling catheterization with scheduled catheter changes. For severe upper urinary tract dilation, surgical urinary diversion procedures—including suprapubic cystostomy or percutaneous nephrostomy—may be necessary.

Etiology of Urinary Retention
　　1. The most common cause involves mechanical obstruction at the urethra or bladder outlet due to various organic pathologies. Urethral lesions include inflammation, foreign bodies, calculi, tumors, trauma, strictures, and congenital anomalies. Bladder neck obstruction may result from bladder neck contracture or fibrosis, bladder neck tumors, acute prostatitis or prostatic abscess, benign prostatic hyperplasia (BPH), or prostate cancer.
　　2. Additionally, pelvic tumors and uterine enlargement during pregnancy can compress the urethra or bladder neck and induce urinary retention. Functional (dynamic) obstruction arises from impaired detrusor contractility or sphincter dyssynergia, commonly secondary to central or peripheral nervous system disorders—such as spinal cord or cauda equina injury or tumor, pelvic surgery-induced bladder nerve damage, or diabetic neuropathy—leading to neurogenic bladder dysfunction.
　　3. Certain medications—including anticholinergics such as atropine, propantheline, and scopolamine—that relax smooth muscle may rarely precipitate urinary retention.

The above outlines optimal therapeutic approaches for urinary retention. We hope this information proves helpful to you.