Have Difficulty Urinating? Understanding Urinary Retention

Urinary retention is the loss or reduced ability to empty the bladder completely. This situation is part of the lower urinary tract / lower urinary tract symptoms (LUTS).

In general, urinary retention is divided into 2 conditions, which are acute urinary retention and chronic urinary retention

1. Acute Urinary Retention

• Usually accompanied by pain
• Can't urinate at all
• Full bladder
• Happened suddenly
• Including emergencies in urology

         2. Chronic Urinary Retention

• Can be painless
• Can still urinate, but not facile
• Inability to completely empty the bladder (incomplete)
• Difficulty starting to urinate (hesitancy)
• Not life threatening, but can cause complications

The causes of urinary retention can be distinguished based on their etiology:

• Supravesika: motor and sensory nerve innervation disorders due to neurological diseases such as stroke, HNP etc
• Vesica: bladder detrusor muscle weakness, antimuscarinic/ anticholinergic drugs (low bladder pressure)
• Infravesika: bladder outlet obstruction (BPH, urethral stricture, meatal stenosis, urethral edema, urethral masses, urethral stones, pelvic organ prolapse), increased urethral resistance, detrusor-sphincter dyssynergia (DSD),

Immediate treatment in cases of acute urinary retention is to decompress the bladder using urethral catheterization, suprapubic puncture or suprapubic catheterization (cystostomy). In most cases, clinicians prefer to insert a urethral catheter and only perform a suprapubic puncture or cystostomy if the urethral catheter failed. Suprapubic catheterization is frequently associated with the incidence of haematuria and catheter obstruction than urinary catheters.

In a study by Horgan et al, it was reported that the incidence of urinary tract infection (UTI) was lower with suprapubic catheterization than with urethral catheterization (18% vs. 40%; p<0.05) and less incidence of urethral stricture at 3-year follow-up ( 0% vs 17%; p<0.01) (Fitz; yoon). Insertion of a suprapubic catheter also carries several risks,  a 2.5% chance of intestinal injury and a 1.8% risk of 30-day mortality. Therefore, The British Association of Urological Surgeons recommends insertion of an imaging-assisted suprapubic catheter (USG).

Before consulting with an Urologist, it is better to record the complaints what you are experiencing. Remembering what you were doing before the complaint was felt, whether you had an injury or not. In addition, collect a complete medical history, including any medical history or medical history. This is useful for doctors to diagnose what diseases you are experiencing.