Aetiology and management of acute female urinary retention

Summary 

Aims

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. 57mmH20 (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.

Keywords: Lower urinary tract symptoms, Female retention, Urodynamics