Chronic incomplete urine retention

Specialty: Nephrology and urology.

• asymptomatic chronic urinary retention
• chronic overdistended bladder

Why it occurs

• Long-term advanced benign prostatic hyperplasia (prostatic growth silently occludes the prostatic urethra; the detrusor hypertrophies and subsequently dilates, gradually losing contractility without causing acute pain)
• Atonic neurogenic bladder (associated with diabetic neuropathy, multiple sclerosis or spinal cord lesions that silently nullify the sensitivity and contraction of the detrusor)
• Grade IV cystocele (massive anterior vaginal prolapse that chronically kinks the urethral canal, making emptying difficult but allowing dripping due to overflow)
• Slowly progressive urethral stricture (narrowing that chronically increases intravesical pressure until detrusor claudication)

Initial workup

Pre- and post-void renal, bladder, and prostate ultrasound (key test to confirm bilateral hydronephrosis, thinning of the renal parenchyma, and measure massive chronic post-void residual, often >400-500 ml); blood work with complete kidney function panel, electrolytes, and arterial blood gases; complete urodynamic study with pressure-flow study; diagnostic cystoscopy.

Standard management

• Tamsulosin — 0.4 mg daily orally to minimize infravesical mechanical resistance
• Clean intermittent catheterization scheduled — performing self-catheterization with a sterile probe 3 to 5 times a day; It is the non-surgical gold standard for bladder emptying and protection of superior kidney function.
• Temporary permanent Foley catheter placement if there is concomitant post-renal acute kidney failure to allow recovery of the glomerular filtration rate.