Management of chronic urinary retention

Abstract

Slow decompression is rarely indicated for patients with high pressure chronic retention and never for those with low pressure chronic retention. In the occasional patient for whom the clinician decides on slow decompression it must be carefully controlled by carefully managed manometric pressure release. In most patients with high pressure chronic retention preliminary drainage should be carried out under careful bacteriological control as well as chemical balance. Surgery to the obstruction can then be performed when the maximum improvement has been achieved in the upper urinary tract and before any infection develops. In patients with low pressure chronic retention no preliminary drainage of the bladder will improve the detrusor action, and definitive surgery to the ouflow obstruction (or if no obstruction exists to reduce outflow resistance) should be the first urethral intervention. If correctly managed, high pressure chronic retention has a good prognosis after transurethral resection. In low pressure chronic retention, however, the prognosis is far less satisfactory as recovery of the detrusor is unlikely, and the patient should be warned accordingly. A regimen of micturition by the clock-discouraging the patient to wait until he has the desire to pass urine-is the only hope of achieving complete or almost complete emptying of the bladder.