Management of Acute and Chronic Retention in Men

Urinary retention is complex and may present in various ways as a result of a myriad of pathologic processes. Retention is >10 times more common in men than in women, and acute urinary retention (AUR) is rare in younger men; men in their 70 s are at five times more risk of AUR than men in their 40 s. Most of the epidemiologic data referred to in the literature are for AUR; data for chronic urinary retention (CUR) are sparse. Management of urinary retention must begin with modifying risk factors for developing AUR by using 5α-reductase inhibitors, follow-up, and early surgical intervention for those who may benefit. Once retention occurs, delay of surgery when possible must be the aim to reduce the risk of perioperative morbidity and mortality as well as to allow the bladder to recover its contractility. Finally, perhaps it is time to use suprapubic catheterisation for retention patients as a first-line approach.