Abdominal and pelvic examination: urethra (for discharge/ meatal stenosis), prepuce (retractability), vaginal examination (evaluation for a pelvic mass).May present with overflow incontinenceor nocturnal enuresis.Painless incomplete voiding of the bladder.Functional or a gradually progressive mechanical obstruction (e.g., BPH, urinary tract cancer).Some factors (e.g., alcohol-induced diuresis, spinal anesthesia, pelvic surgery, certain drugs, UTI ) can precipitate acute on chronic urinary retention.Obstructive etiologies are more common (esp.Treated with α-blockers or surgical incision of the bladder neck. Bladder neck dysfunction: The bladder neck fails to open completely during micturition.Due to increased urethral sphincter tone : sympathomimetics, nonselective beta blockers, opioids ).Due to d etrusor underactivity : anticholinergics, first-generation antihistamines, tricyclic antidepressants, antipsychotics, calcium channel blockers, antiparkinson agents.Trauma (e.g., pelvic fracture, surgery /radiation of the pelvis ).Damage to pelvic splanchnic nerves ( bladder denervation ) → causes ↓ bladder sensation and detrusor contractility → infrequent, incomplete urination → overflow incontinence.Congenital anomalies of the spinal cord (e.g., meningomyelocele, spina bifida).Spinal cord compression (e.g., intervertebral disc protrusion/ herniation, tumors, epidural abscess / hematoma ) or trauma.Neurological causes ( neurogenic bladder ).Detrusor underactivity and/or sphincter overactivity.Urethral/ bladder trauma (e.g., urethral transection).Pelvic masses (e.g., benign/malignant ovarian tumor).Urethritis (inflamed, edematous urethra).Urethral stricture (see “Subtypes and variants” below.). Benign prostatic hyperplasia (most common).Treating the underlying cause (e.g., alpha adrenergics and/or TURP for BPH) is essential to prevent recurrence and complications due to urinary retention, such as UTI, nephrolithiasis, and renal failure. Further evaluation depends on the patient history and physical examination. These include renal function tests to assess for renal damage ( obstructive nephropathy) and ultrasound of the kidneys, ureter, and bladder to identify the underlying cause and possible complications (e.g., hydroureteronephrosis). Therefore, urgent bladder catheterization should precede diagnostics. AUR is usually diagnosed clinically and is considered an urological emergency. Patients with chronic urinary retention (CUR) are typically unable to void completely but do not experience pain. Patients with acute urinary retention ( AUR) present with a sudden, painful inability to void and a tender, distended bladder on palpation. The causes can be either mechanical (e.g., benign prostatic hyperplasia, tumors, urethral strictures) or functional (e.g., detrusor underactivity due to peripheral neuropathy, anticholinergic drugs). Urinary retention is the inability to voluntarily empty the bladder.
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