Prise en charge d'une rétention aiguë d'urine

The acute urinary retention (AUR) is a medical urgency defined as a sudden and painful inability to void voluntarily. The excitement even a confusionnel syndrome can dominate the clinical presentation and delay the diagnosis. This article deals with the steps of the treatment of the AUR from the point of view of the emergency physician. A triggering factor is not always identified and the AUR is often attributed to the progress of a benign prostatis hyperplasia (BPH). The initial clinical examination attempts to look for a painful bladder distension and for the signs of complications (haematuria, sepsis) to choose the most adapted technique of drainage. A suprapubic catheterization is contraindicated in case of: antiplatelets agents, anticoagulants, bladder cancer and uncertainty on bladder distension. The urethral catheter is contraindicated in case of acute pelvic trauma, suspicion of urethral fracture, acute prostatitis and urethral stricture. Except these situations, both techniques are mostly possible. The classical undelayed prostatic surgery was associated to an excess of death and morbidity. At present, a conservative attitude is widely practiced in the world and avoid an immediate surgery for three men on four. After initial catheterization, a test without catheter is a standard. The introduction of a α-blocker treatment doubles the chances of success of this test. The AUR is a problem of public health in the ageing western populations, considering the increase of AUR with the age, the link between the metabolic syndrome and the progression of the BPH.