Acute urinary retention

Etiology

• Prostate
  • Benign prostatic hypertrophy
• Medication
  • Sympathomimetic
    • Alpha-adrenergic: ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine
    • Beta-adrenergic: isoproterenol, metaproterenol, terbutaline
  • Antidepressants: imipramine, nortriptyline, amitriptyline, doxepin, amoxepine, maprotiline
  • Antiarrhythmics: quinidine procainamide, disopyramide
  • Anticholinergics: atropine, scopolamine, clidinium, glycopyrrolate, mepenzolate, oxybutynin, flavoxate, hyoscyamine, belladonna, homatropine, propantheline, dicyclomine
  • Antiparkinsonian medications: trihexyphenidyl, benztropine, amantadine, levodopa, bromocriptine
  • Hormone replacement: progesterone, estrogen, testosterone
  • Antipsychotics: haloperidol, thiothixene, thioridizine, chlorpromazine, fluphenazine, prochlorperazine
  • Antihistamines: diphenhydramine, chlorpheniramine, brompheniramine, cyproheptadine, hydroxyzine
  • Antihypertensives: hydralazine, nifedipine
  • Muscle relaxants: diazepam, baclofen, cyclobenzaprine
  • Miscellaneous: indomethacin, carbamazepine, amphetamines, dopamine, vincristine, morphine and other opiates, anesthetics

Investigations

• Bladder scan
• Abdominal ultrasound to rule out hydronephrosis

Management

• Foley catheterization
• Monitor lytes, urine lytes, urine output
• If post-obstructive diuresis
  • Monitor urine output, replace 75% by volume with half-normal saline
  • Monitor electrolytes