19 Urinary retention

Introduction Impairment of bladder emptying maymanifest as complete or partial urinary retention, and be either acute or chronic. The conditions under which retention occur are many and varied, indicating there must be many different causes which effect the same end result. Acute complete urinary retention is not uncommon following surgery irrespective of the operation site and is attributed to pain and the effects of postoperative analgesia, with full recovery of voiding when these effects wear off. Although complete retention can occur acutely, it may be due to a high post-void residual volume, of which the patient may or may not be aware. Partial retention may be discovered incidentally or as a result of investigation of a patient reporting the sensation of incomplete voiding in association with voiding difficulty or a poor stream. When a voiding disorder occurs in conjunction with detrusor overactivity, as commonly occurs with spinal cord disease, it may be conceptually helpful to think of the high residual volume as the result of “incomplete emptying.” Patients with retention may present to a urologist, uro-gynecologist or neurologist.