Etiology and management of urinary retention in women

Abstract

Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a “psychogenic basis” should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler’s syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.

A Case of Female Acute Urinary Retention Presenting to the ED

“…Other obstructive causes of urinary retention include; cervical cancer, urethral stenosis, urethral cancer and anti-incontinence surgery [11, 12]. A recent South African review, reporting on 31 women presenting with urinary retention over a 9-year period, identified urethral carcinoma (4/31) and cervical carcinoma (4/31) as the commonest underlying pathology [13].…”

“…Overall, neurologic conditions (e.g., Fowlers syndrome, spinal cord-compression, and multiple sclerosis) make up the most common causes of acute urinary retention in young to middle-aged women [11, 12]. In a four-year review of cases presenting to their centre, Kavia and colleagues reported Fowlers syndrome (poor relaxation of the external urethral sphincter) as the most common cause of female urinary retention.…”

An Unusual Cause of Urinary Retention in a Young Female: A Case Report

“…Rare cases of malignant transformation have also been reported [7]. Acute urinary retention in itself is uncommon in women, and bladder or urethral tumors could be considered as one of the possible differential diagnoses [5]. To the best of our knowledge, urinary retention due to a prolapsing IMFT arising from the urinary bladder has never been reported in the literature.…”

“…Bladder or urethral tumors can be one of the possible differential diagnoses in such a scenario [5]. We report a patient with IMFT who presented to our emergency department with acute urinary retention due to a prolapsing mass from the urethra.…”

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

“…[1516] Urine analysis appeared as the most useful laboratory test. Although infection of the urinary tract has been reported among underlying factors for urinary retention, its role as a cause or a concurrence in AUR remains uncertain.…”