Evaluation

The diagnosis of urinary retention is established relatively easily. Patients typically complain of severe su-prapubic pain and the inability to void. Physical examination often reveals a lower midline abdominal mass; however, dullness with percussion of the lower abdomen may be a more sensitive sign of bladder fullness. Apart from establishing urinary drainage, the next step is to differentiate mechanical obstruction from neuro-physiologic dysfunction. Pelvic and rectal examination may identify a large obstructing pelvic tumor, while a focused neurologic exam demonstrating sensory or motor abnormalities may suggest a neurophysiologic cause. Further enquiry should be made into baseline voiding status, prior episodes of retention and associated treatment, overall health status, as well as the presence of medications or chronic illnesses known to undermine bladder function. Since urinary tract infection can complicate or precipitate urinary retention, the presence of irritating voiding symptoms or fever should be questioned. Renal insufficiency may complicate longstanding or severe urinary retention; therefore, azotemia and associated electrolyte abnormalities must be ruled out. Laboratory evaluation includes a CBC, serum electrolytes, BUN, and serum creatinine. Once urine becomes available, a urinalysis and urine culture should also be performed. Imaging of the upper tracts is indicated if renal dysfunction is present. Renal size and cortical thickness may suggest the degree and duration of obstruction and may also provide some measure of salvageable renal function. Ultrasound appears to be the most cost-effective imaging modality in this regard (Reisman et al. 1991).

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