Urination hesitancy

Specialty: Nephrology and urology.

• micturition latency
• difficulty starting urination
• urinary hesitancy

Why it occurs

• Benign prostatic hyperplasia (the detrusor requires more time and pressure to overcome the resistance of the obstructed prostatic urethra)
• Psychogenic dysfunction or paruresis (social anxiety or shy bladder syndrome that sympathetically inhibits the relaxation of the bladder neck)
• Autonomic neuropathy (diabetic neuropathy that damages the bladder afferent fibers, delaying the micturition reflex)
• Drugs with anticholinergic or sympathomimetic effects (tricyclic antidepressants, first generation antihistamines, pseudoephedrine, which block the detrusor or contract the bladder neck)
• Stenosis or rigidity of the bladder neck (post-adenomectomy or idiopathic bladder neck sclerosis)

Initial workup

Detailed voiding diary for 3 days to record voiding times and volumes; urinary flowmetry; renal and vesicoprostatic ultrasound with residual measurement; Complete urodynamic study (cystomanometry and pressure-flow study) if a neurological cause is suspected.

Standard management

• Tamsulosin — 0.4 mg daily orally to selectively relax the alpha-1a receptors of the bladder neck and prostate
• Discontinue or replace the drugs with anticholinergic profile involved
• Diazepam (2-5 mg orally every 12 hours as a muscle relaxant if striated urethral sphincter spasm secondary to extreme anxiety or pelvic floor dysfunction is suspected).