Retention and Bladder-Emptying Disorders

Abstract

Incomplete bladder emptying and urinary retention can cause a number of bothersome lower urinary tract symptoms including voiding symptoms (hesitancy, slow stream, incomplete emptying), storage symptoms (frequency, nocturia, incontinence, urgency), and urinary tract infections. In more severe cases of urinary retention and elevated bladder storage pressures, upper urinary tract decompensation can result. To properly understand the myriad of disorders that can cause urinary retention, it is important to have an understanding of the anatomy and voiding physiology. In essence, bladder-emptying disorders can result from bladder outlet obstruction, detrusor underactivity, or a combination of both.

Appendix 1: ICS 2002 Definitions of LUTS as They Pertain to Urinary Retention and Bladder-Emptying Disorders

International continence society subcommittee standardization of terminology in lower urinary tract function (2002)
Terminology	Definition
Normal detrusor function	A voluntarily initiated continuous detrusor contraction that leads to complete bladder emptying within a normal time span and in the absence of obstruction. For a given detrusor contraction, the magnitude of the recorded pressure rise will depend on the degree of outlet resistance
Lower urinary tract symptoms (LUTS)	The subjective indicator of a disease or condition as perceived by the patient, caregiver, or partner that may lead him/her to seek help from healthcare professionals Storage symptoms: frequency, nocturia, urgency, urinary incontinence Voiding symptoms: slow stream, splitting or spraying, intermittency, hesitancy, straining, terminal dribble Post micturition symptoms: feeling of incomplete emptying, post-micturition dribble
Detrusor underactivity	A contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span
Acontractile detrusor	One that cannot be demonstrated to contract during urodynamic studies
Bladder outlet obstruction	The generic term for obstruction during voiding and is characterized by increased detrusor pressure and reduced urine flow rate. It is usually diagnosed by studying the synchronous values of flow rate and detrusor pressure Further stated that bladder outlet dysfunction has been “defined for men but, as yet, not adequately in women and children”
Dysfunctional voiding	Voiding characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated muscle during voiding in neurologically normal individuals It has also be termed “non-neurogenic neurogenic bladder,” “idiopathic detrusor sphincter dyssynergia,” or “sphincter overactivity voiding dysfunction”
Detrusor sphincter dyssynergia	A detrusor contraction concurrent with an involuntary contraction of the urethral and/or periurethral striated muscle. Occasionally, flow may be prevented altogether Occurs in patients with a supra-sacral lesion and is uncommon in lesions of the lower cord
Non-relaxing urethral sphincter obstruction	Usually occurs in individuals with a neurological lesion and is characterized by a non-relaxing, obstructing urethra resulting in reduced urine flow Found in sacral and infra-sacral lesions. This term replaces “isolated distal sphincter obstruction”
Acute retention of urine	A painful, palpable, or percussible bladder, when the patient is unable to pass any urine In certain circumstances pain may not be a presenting feature (herniated vertebral disk, post-anesthesia, postpartum)
Chronic retention of urine	A non-painful bladder, which remains palpable or percussible after the patient has passed urine. Such patients may be incontinent Implies a significant residual urine (a minimum figure of 300 mL has been previously mentioned in men)
Benign prostatic obstruction	A form of bladder outlet obstruction and may be diagnosed when the cause of outlet obstruction is known to be benign prostatic enlargement, due to histologic benign prostatic hyperplasia
Benign prostatic hyperplasia	A term used (and reserved) for the typical histological pattern which defines the disease
Benign prostatic enlargement	Prostatic enlargement due to histologic benign prostatic hyperplasia The term “prostatic enlargement” should be used in the absence of prostatic histology