Neuro-Urology pp 207-231 | Cite as

Urinary Retention and Voiding Dysfunction

  • Dominique Malacarne PapeEmail author
  • Victor W. Nitti


The physiology of voiding is intricate and complex, and there is vast potential for disruption of normal voiding patterns. For adequate bladder emptying to take place, the bladder needs to generate a pressure of adequate strength and duration to overcome the resistance set by the outlet. Disruption in the generation of the bladder pressure required, or of the outlet to allow passage of urine, will result in incomplete bladder emptying. Underlying these pathophysiological processes is the gateway for proper development of new therapies. It is important to have a solid knowledge of terminology applied to the genitourinary tract for purposes of reporting results and developing treatment guidelines.

A thorough evaluation is crucial to properly diagnose patients with bladder-emptying disorder and to subsequently implement treatment strategies. Appropriate studies, including post-void residual, uroflow, labs, imaging, and, the gold standard, urodynamics, with or without fluoroscopy, are then added to a comprehensive workup to arrive at a diagnosis. Nomograms should be used when needed to help standardize the evaluation of patients, but in certain instances, evaluation of each individual case as a separate entity is of paramount importance. Patients should be thoroughly counseled regarding treatment options and potential risks and benefits associated with each. Lastly, patients at high risk for upper tract deterioration should be closely monitored and reevaluated periodically to reduce the incidence of dangerous long-term effects of incomplete bladder emptying.


Urinary retention Incomplete bladder emptying Voiding dysfunction Detrusor underactivity Bladder outlet obstruction 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, Female Pelvic Medicine and Reconstructive SurgeryNYU Langone Medical CenterNew YorkUSA

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