Introduction

Learning objectives

Recognize the most common causes of acute urinary retention.
Apply bladder decompression as the initial priority measure.
Identify the situations that require urgent referral.

Video lesson

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Summary

Acute urinary retention is the inability to urinate, generally associated with a distended bladder.

Possible causes

BPH;
urethral stricture;
medications;
clots;
neurological disorders;
infection/inflammation;
postoperative.

Initial approach

The priority is to decompress the bladder by catheterization, when there are no contraindications.

⚠️ Urgent referral

inability to place the catheter;
traumatic attempts;
significant hematuria;
suspected urethral injury;
retention associated with renal failure;
sepsis;
acute neurological abnormalities.

⚠️ Alert

If there is blood at the meatus after pelvic trauma, do not make multiple blind catheterization attempts.

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Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Urinary retention