Best Nonsurgical Managements of Acute Urinary Retention: What's New?

Michael Baboudjian; Benoit Peyronnet; Romain Boissier; Grégoire Robert; Jean-Nicolas Cornu; Vincent Misrai; Benjamin Pradere


Curr Opin Urol. 2022;32(2):124-130. 

In This Article

Abstract and Introduction


Purpose of Review: To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR).

Recent Findings: A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53–3.8), and to reduce time-to-discharge (−89.68 min, 95% confidence interval −160.55, −18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.

Summary: The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.


Acute urinary retention (AUR) is one of the most common urological emergencies accounting for about 0.4% of emergency department (ED) visits.[1] More than 10% of men in their 70s and one third of men in their 80s are expected to present an AUR, with significant impact on patients' health-related quality of life, and a substantial additional cost for healthcare systems.[2,3] Recent data indicate an increasing incidence of AUR. For instance, in a recent study examining data of over 600 French EDs between 2014 and 2019, the incidence of AUR had increased of more than 30%.[1] The resurgence of AUR is an inevitable public health issue in the western world with the increased life expectancy.

Commonly, the immediate management of AUR involves bladder drainage using either a suprapubic or a urethral catheter, followed by medical therapy and a subsequent trial without catheter (TWOC).[4] Recently, a growing body of evidence pointed out appealing alternatives to this traditional pathway: from the optimization of medical therapy, organization of TWOC, to alternatives to urethral catheter (Figure 1). This narrative review aims to report the different nonsurgical strategies for the management of AUR.

Figure 1.

New approaches in the non-surgical management of acute urinary retention. TWOC, Trial without catheter.