Aetiology and Management of Acute Female Urinary Retention

Abstract

Interest in female urinary retention has increased recently because of improved understanding in the pathophysiology as well as the availability of specialised treatments such as sacral neuromodulation. There is little in the literature regarding the incidence and aetiology of urinary retention in females. We therefore undertook a review of all female retention patients presenting to our urology unit over an 11 year period. Methods: 300 females presented with retention in 11 years January 1996 to January 2007 (7% of the male incidence). 81 presented more than once. Median age was 67. Aetiology included urethral stenosis (n = 51), urinary tract infection (n = 33), constipation (n = 23), neurological causes (n = 14), gynaecological causes (n = 16), non urological post-operative patients (n = 21), medications (n = 7) and clot retention secondary to bladder cancer (n = 12). Results: Ultrasound (n = 240) was carried out in the majority, cystoscopy (n = 140), and urodynamics in a minority (n = 38). Urethral pressure profilometry (n = 38) revealed significantly higher closure pressures as compared to a control group -median 90 vs. 57 mmH20 (p = 0.02). 245 had successful trials without catheter. Prior to this, treatments included cystoscopy and urethral dilatation (n = 73), laxatives (n = 25) or antibiotics (n = 29). Initially 54 patients were taught intermittent self-catheterisation; 38 patients were unable to perform this, and left with a long-term catheter. Conclusions: The number of female retentions encountered in our practice is fairly high, with very few of these fitting the criteria for sacral nerve stimulation. In a third no aetiology was found. Approximately half of those who successfully voided did so with no treatment.

Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients

“…A retrospective review reported the most common etiologies as urethral stenosis, urinary tract infection, nonurological postoperative retention, and clot retention, whereas no etiology was found in a third. [23] Another report on inpatient database revealed the most common causes of AUR in women as malignancy (36%) and neuropathic bladder dysfunction (16%). [24] García-Fadrique et al .…”

Female Urinary Retention: Observations from a Retrospective Case Note Review

“…Previously published papers suggest that a detailed history and examination is often all that is required to establish the cause of retention. 4,13,14 Some authors have advocated the use of an ultrasound scan and either a flexible 4,13 or a rigid cystoscopy 14 in the further investigation of these females. In our series, ultrasound imaging only revealed pathology in 3 of the 65 females while none of the cystoscopies revealed any cause for the retention.…”

“…Ahmad et al found urethral stenosis to be the cause of retention for many of their female patients. 14 This diagnosis was only made after cystoscopy. Urethral stenosis is more common in post-menopausal women secondary to urogenital atrophy caused by hormonal insufficiency.…”

Female voiding dysfunction: Prevalence and common associations

“…A recent analysis of 300 female presentations (median age, 67 years) with acute retention nominated urethral stenosis (n = 51) as the most common cause, followed by urinary tract infection (n = 33), constipation (n = 23), postoperative non-neurological (n = 21), gynecological (n = 16), and medications (n = 7) [41].…”