The Management of Acute Urinary Retention: Treating the Curse of the Aging Male

Acute urinary retention (AUR) is a common urological emergency usually associated with bladder outlet obstruction due to benign prostatic hyperplasia (BPH). BPH becomes increasingly prevalent in an aging population with 80 to 90 % of men in their eighth decade of life having histological evidence of BPH in post-mortem studies. A review of the literature to date has been performed to make recommendations on the best management of AUR associated with BPH. Urethral or suprapubic catheterisation followed by medical therapy with an alpha-blocker prior to a trial of voiding is currently the mainstay of treatment in men presenting with a first episode of painful retention secondary to BPH. A selective alpha 1 blocker should be started as soon as possible after catheterisation with a trial of voiding attempted after a minimum of 48 hours treatment. At presentation with AUR consideration should be given to starting a 5-alpha reductase inhibitor, in men with a prostate >40 g or PSA >1.4 ug/l to reduce the risk of disease progression. In patients unlikely to pass a trial of voiding such as those with a high retention volume (approximately >1000 ml) consideration should be given to urgent surgery. Definitive surgical treatment involves bladder outlet surgery, if necessary, in the form of a prostatectomy, with the gold standard currently being a transurethral resection of the prostate (TURP) and should best be attempted as soon as possible out with the emergency setting and preferably without a catheter.