Treatments — Prostate & Bladder
Urinary Retention — Immediate Treatment & Investigation
Urinary retention — the inability to pass urine — is a urological emergency when acute, and a significant quality-of-life problem when chronic. Mr. Jesuraj provides expert assessment, immediate management and a structured investigation pathway to identify and treat the underlying cause.
⚠️ Acute Urinary Retention — Seek Help Now
If you are completely unable to pass urine and experiencing significant pain or discomfort, this is a medical emergency. Go to your nearest A&E department or call 999.
If you have been discharged with a catheter following acute retention, or are experiencing difficulty urinating, contact us for an urgent specialist appointment.
Understanding the Condition
What Is Urinary Retention?
Urinary retention is the inability to completely empty the bladder. It exists on a spectrum — from acute complete retention (sudden inability to pass any urine) to chronic incomplete retention (passing urine but leaving a significant volume behind). Understanding which type you have, and identifying the cause, determines the appropriate management.
Retention is significantly more common in men — often driven by prostate enlargement (BPH). However, it can affect women, and there are many other causes in both sexes including neurological conditions, medications, and post-surgical changes.
Catheterisation is the immediate treatment — but it is not the solution. The goal is to identify and treat the underlying cause so that the catheter can be removed and normal voiding restored where possible.
Acute Retention
Sudden — Complete Inability to Urinate
Sudden painful inability to pass any urine. Bladder becomes distended and painful. Requires emergency catheterisation within hours. Common trigger: BPH flare, medications (e.g. decongestants, anticholinergics), constipation, post-surgery, or urinary tract infection.
⚠️ Seek A&E immediately if this is happening now
Chronic Retention
Gradual — Incomplete Bladder Emptying
Gradual build-up of residual urine in the bladder over time — often painless. Can cause recurrent infections, overflow incontinence (leaking from an overfull bladder), and ultimately back-pressure damage to the kidneys (hydronephrosis) if untreated.
Book an urgent specialist appointment
Causes
Common Causes of Urinary Retention
A thorough assessment is essential — treatment depends entirely on the underlying cause.
Obstructive Causes — Men
- Benign prostatic hyperplasia (BPH) — most common
- Prostate cancer
- Urethral stricture (scarring)
- Phimosis (tight foreskin) — rare
- Bladder stone or clot retention
Obstructive Causes — Women
- Pelvic organ prolapse (cystocoele, rectocoele)
- Urethral stricture
- Pelvic mass (fibroid, ovarian cyst)
- Post-surgical — after pelvic floor repair
- Retroverted gravid uterus (pregnancy)
Neurological Causes
- Diabetic cystopathy (autonomic neuropathy)
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury or compression
- Stroke (post-CVA)
- Cauda equina syndrome — emergency
Other Causes
- Medications — anticholinergics, opioids, decongestants, antidepressants
- Post-operative retention — after any surgery
- Urinary tract infection (acute)
- Constipation — particularly in elderly
- Detrusor underactivity (weak bladder muscle)
- Fowler’s syndrome — young women
🚨 Cauda Equina Syndrome — if urinary retention is accompanied by saddle anaesthesia (numbness in the perineum/inner thighs), bilateral leg weakness, or loss of bowel control, this is a surgical emergency. Call 999 or go immediately to A&E.
Immediate Treatment
Immediate Management of Urinary Retention
Catheterisation relieves the immediate problem — but finding the cause and treating it is the essential next step.
Urethral Catheterisation
A fine catheter is passed through the urethra into the bladder to drain the urine. This is the primary and most rapid treatment for acute retention. The volume drained (often 500–1,500ml or more) confirms the diagnosis.
Catheterisation is arranged as an emergency through A&E or the GP out-of-hours service. Mr. Jesuraj can arrange catheterisation at Best Life Clinic for non-emergency situations during clinic hours.
Trial Without Catheter (TWOC)
After a period of catheterisation (typically 24–72 hours for acute retention), a trial without catheter is attempted — ideally with an alpha-blocker (e.g. tamsulosin) to relax the prostate and bladder neck. Success rates are significantly higher with this pharmacological support.
TWOC should be supervised by a urologist who can quickly re-catheterise if needed and plan next steps if the trial fails.
Suprapubic Catheter
Where urethral catheterisation is not possible — due to urethral stricture, trauma, or patient preference for long-term catheterisation — a suprapubic catheter (inserted through the abdomen into the bladder) is placed. This is a minor surgical procedure performed under local anaesthetic.
Mr. Jesuraj performs suprapubic catheter insertion at Best Life Clinic or Ramsay Tees Valley Hospital.
Clean Intermittent Self-Catheterisation (CISC)
For chronic incomplete retention where the bladder does not empty fully — self-catheterisation (passing a small catheter several times a day) can be more appropriate than an indwelling catheter. Mr. Jesuraj and the specialist nursing team provide full CISC teaching.
CISC maintains bladder health, reduces infection risk, and allows normal daily activities — preferable to a permanent catheter in many patients.
Investigation
Finding the Cause — Evaluation Pathway
Catheterisation fixes the immediate problem. Investigation finds the cause and guides definitive treatment.
History & Examination
Duration of symptoms, previous voiding problems, medications (anticholinergics, opioids, decongestants), neurological symptoms, constipation, prostate symptoms. Examination: prostate size and consistency, neurological assessment, abdominal examination.
Blood Tests
Renal function (creatinine, eGFR) — to assess for obstructive uropathy. PSA — if prostate pathology suspected. Glucose — diabetic cystopathy. Blood count, electrolytes.
Urine Tests
Dipstick, MSU — exclude UTI as precipitating cause. Urine cytology if haematuria is present or bladder tumour suspected.
Bladder Ultrasound
Post-void residual volume — essential. Assess bladder wall thickness, upper tract dilatation (hydronephrosis), and bladder stones.
Uroflowmetry
Flow rate measurement — once catheter is removed. Low Qmax with obstructive flow curve suggests outlet obstruction. Combined with PVR confirms diagnosis.
Urodynamics
Pressure-flow study — essential to differentiate bladder outlet obstruction (high pressure, low flow) from detrusor underactivity (low pressure, low flow). These require completely different treatment approaches.
Cystoscopy
Direct visualisation of the urethra and bladder — identifies urethral stricture, bladder neck obstruction, bladder stone, or bladder tumour as a cause of obstruction.
Imaging
Renal ultrasound or CT urogram where upper tract obstruction or renal pathology is suspected. MRI prostate / spine if neurological cause is possible.
Definitive Treatment
Treating the Underlying Cause
Once the cause is identified, definitive treatment can restore normal voiding — or optimise management where complete resolution is not possible.
Aquablation, Rezūm, TURP, or long-term medical therapy with alpha-blockers and 5-alpha-reductase inhibitors — depending on prostate size, patient fitness and preference.
Urethral dilatation, optical urethrotomy (incision under cystoscopic vision), or urethroplasty (open surgical reconstruction) — depending on stricture length and location.
Cessation or substitution of the causative drug in discussion with the prescribing clinician. Alpha-blocker therapy to assist voiding.
Clean intermittent self-catheterisation (CISC), medications to reduce detrusor overactivity, Botox bladder injection, or neuromodulation — based on urodynamic findings.
When the bladder muscle is weak and cannot generate sufficient pressure to void — CISC is often the most appropriate long-term solution. No drug reliably improves detrusor contractility.
Where definitive treatment is not possible — urethral or suprapubic catheter with regular changes and monitoring. Mr. Jesuraj provides catheter change clinics and catheter care support.
Expert Help — When You Need It
Discharged with a catheter? Struggling to pass urine? Recurrent retention? Don’t wait. Contact Mr. Jesuraj’s team for an urgent specialist appointment — usually within 7 days.