Urinary Retention in Men

What is Urinary Retention?

Urinary retention in men happens when you cannot empty all the urine from your bladder. It can happen suddenly, and you may feel bladder pressure and have to strain to urinate. It can also develop gradually, and you may be unaware that a large amount of urine remains in your bladder after you urinate. There are several reasons why this can occur.

Enlarged prostate- An enlarged prostate may block the urine flow coming from the bladder.
Decreased bladder function- If the bladder does not squeeze appropriately, urine cannot leave the bladder. Having an enlarged prostate for several years puts extra strain on the bladder because the enlarged prostate can partially block urine flow. This can affect the bladder’s ability to function over time.
Constipation- A large amount of stool in the rectum can put pressure on the bladder and cause the bladder to not empty well.
Drug-induced- Medications like anticholinergics, opioids, and anesthetics can prevent the bladder from completely emptying. That is why sometimes after surgery, it becomes harder to urinate and you may experience urinary retention.

Your provider may order one or more of the following tests to determine the cause of your urinary retention.
These tests are needed so your provider can make the most informed decision on what future treatment will be most beneficial for you.

Cystoscopy– this test is done in the office. Your provider will insert a small camera into the urethra to view the urethra, prostate, and bladder. This test helps your provider determine if your prostate is blocking the urine flow. Your provider can also see the tissues and muscles of the bladder. The camera is inserted for 2-3 minutes. We will use numbing gel to numb your urethra prior to camera insertion.

Urodynamics– This test is done at Urology San Antonio’s Medical Center location. By measuring pressures in the bladder and assessing urine flow, this test is used to determine how well your bladder is functioning and why urinary retention is occurring. It tells your provider if the urinary retention is a result of a bladder problem, a prostate problem, or both. This test takes about 30-60 minutes.

Transrectal Ultrasound of the Prostate– This test may be requested by your provider if you are interested or a candidate for the UroLift or Rezum procedures. This is an ultrasound of your prostate that measures prostate size, shape, and location. A small probe is gently inserted into the rectum by an ultrasound technician. This test takes about 5 minutes.

Medications – If the cause of your urinary retention is determined to be prostate obstruction, alpha-blockers like tamsulosin (Flomax) or alfuzosin (Uroxatral) may be prescribed to promote better urine flow.
Temporary urinary catheter – A catheter may be inserted temporarily in the following circumstances: while you start a medication that will help your urinary flow, while your constipation is resolving, while the anesthesia wears off, while you stop/reduce opioid use, or while you undergo the testing listed above.
If your urinary retention is determined to be from prostate obstruction, one of the following procedures may be recommended by your provider.

TURP – A surgery in which the prostate tissue that is blocking the urine flow is carved away.
Aquablation– A surgery in which prostate tissue is removed using a high-power water jet.
UroLift– A minimally invasive procedure in which prostate tissue is lifted away from the urethra via small clips.
Rezum– A minimally invasive procedure in which steam is injected into the prostate tissue which helps to reduce the size of the prostate.
Simple Prostatectomy- A surgery in which the area of the prostate that is causing obstructed urine flow is removed through incisions in the abdomen.

If it has been determined that the cause of your urinary retention is due to a bladder that does not contract or squeeze well, you may need a permanent urinary catheter.