Failure of the lower urinary tract to drain adequately is one of the most common presenting emergencies seen by the practicing urologist. The wide variety of pathologies that can cause this problem needs to be taken into account when assessing the patient, as it is important not to subject the patient to undue risks.

In the emergency situation, the most common presenting symptom is that of urinary retention (UR), which itself can present in varied forms. It is often asso ciated with pain and an intense desire to pass urine, most commonly termed acute urinary retention (AUR) (Fitzpatrick and Kirby 2006; Emberton and Anson 1999; Weiss et al. 2001), but it can also be a painless entity, sometimes noted by a report of not passing urine for several hours or even days, termed chronic urinary retention (CUR) (Kurasawa et al. 2005; Chooong and Emberton 2000). In some circumstances, presentation is not associated with a full urinary bladder but with a sensation of needing to void when the bladder is empty or near-empty. In some cases this can itself cause significant distress, and along with the discomfort felt by those in AUR, exemplifies the rapidity needed in the assessment and treatment of these patients.

Because of the variety of conditions causing UR, it is difficult to design a simple, single algorithm for their management. If the advice in this chapter is followed, however, we hope that the reader will be able to manage effectively the majority of problems seen in everyday practice.

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