Urinary Retention Treatment: Specialists in NYC
Urgent Care for Retention of Urine (Inability to Urinate) in Men and Women
At New York Urology Specialists we offer urgent same day and next day evaluation and treatment for symptoms of urinary retention. If you are experiencing difficulty passing urine and feel incomplete bladder emptying, you need to see a board-certified experienced urologist as you may have retention of urine in the bladder.
At New York Urology Specialists, our center is fully equipped with sophisticated diagnostic equipment including digital cystoscopy, in-office bladder ultrasound, and automated urinalysis to assist us in the diagnosis and treatment of urinary retention. We are able to offer more than 95% of treatments for urinary retention on the spot in our office. In rare circumstances, we will refer you to an affiliated hospital or surgical center if a surgical treatment that cannot be performed in the office settings is necessary.
We offer medical treatment, urinary catheterization, treatment for urinary stricture disease, BPH and other causes of urinary retention. We also remove and change urethral Foley catheters and suprapubic catheters. In-home catheter changes are available.
We are able to help many of our patients to get rid of foley catheters through problem-directed treatment of the underlying problem.
What is Urinary Retention?
Urinary retention refers to the inability to empty the urinary bladder.
There are 2 types of urinary retention: non-obstructive urinary retention and urinary retention caused by blockage or obstruction. In some patients, urinary retention may be caused by a combination of obstruction and non-obstructive urinary retention.
Non-obstructive urinary retention can occur in men or women of all ages. Typically non-obstructive urinary retention is caused by poor functioning of bladder muscles or nerves that control bladder emptying. Sometimes this may be caused by neuropathy or for unknown reasons.
Obstructive urinary retention is much more common and is caused by blockage of urine flow. In men, the most common cause of blockage is enlarged prostate or urethral stricture. In women, urinary retention can be caused by pelvic masses, large fibroids or pelvic floor prolapse (cystocele, uterine prolapse).
Urinary retention may be partial or complete.
Partial urinary retention occurs when the urinary bladder empties only partially after urination. Bladder ultrasound can determine the post-void residual (PVR) volume of the urine left in the bladder after urination. Usually, the post-void residual testing is performed in combination with the uroflow (uroflowmetry) test to determine the speed of urine flow.
Complete urinary retention occurs when the bladder does not empty at all or empties minimally with a large amount of urine left over. A patient may not be able to urinate at all despite having an urge to pee and pain in the bladder. Some patients may be urinating small amounts of urine frequently, but the bladder may hold greater than 500 ml or as much as 1000-2000 mL of urine. Complete urinary retention is a dangerous condition which may affect kidney function, predispose to urinary tract infections and cause blood in urine.
Sometimes patients may be incontinent due to overflow urinary retention. In this situation, the bladder becomes so full that the urinary sphincter muscle that normally keeps one from leaking urine gets over-powered and urine leaks through as an overflowing river goes through a dam.
Symptoms of Urinary Retention
Occasionally, urinary retention may be minimally symptomatic. Commonly urinary retention symptoms include lower abdominal discomfort, an urgency to urinate, a sensation of incomplete bladder emptying, pressure and pain.
Frequent urination may be a sign of urinary retention. With complete urinary retention, you may feel that your bladder is full and you need to urinate but unable to pass urine. Slow urine stream and waking up at night to urinate may also be signs of urinary retention or incomplete bladder emptying. Blood in urine and frequent UTI may also be caused by urinary retention.
What is the Normal Amount of Urine that Can be Left in the Bladder after Urination?
The amount of urine left in the urinary bladder after peeing depends on the age and sex of the patient, Some medications and medical problems such as diabetes or multiple sclerosis may affect how well the bladder empties. To some extent, the amount of urine present in the bladder prior to urination also affects how much is left at the end of urination. Normal bladder capacity is around 500 ml (16 oz) but varies.
What Happens When the Bladder Does Not Empty Completely?
For the purposes of explanation, let’s assume that the amount the urinary bladder can hold is normal (normal bladder capacity) of around 500 ml. If a patient has incomplete bladder emptying with 150 ml left in the bladder after urination, that means that 30% of the bladder (150 ml left / 500 ml capacity) is filled already right after they have urinated. As a result, the time they have to fill the bladder (the time until they get the urge to pee again) is shorter by 30%. A patient will have frequent urination and possibly a sensation of incomplete bladder emptying.
If bladder capacity is also small, for example, if bladder can only hold 300 ml, and post-void residual is 150 ml, then the bladder empties only half-way (150 ml / 300 ml capacity), and this may be one of the reasons people with incomplete bladder emptying have a frequent urge to urinate. Patients with small bladder capacity and incomplete bladder emptying usually feel an urge to pee and frequent urination.
Younger patients should not have any urine left in the bladder after urination or a minimal amount. In general, women should also have minimal to no urine left; in older women, up to 50 mL of urine may be acceptable. UTI can increase the amount of residual urine in the bladder. It is best to test for post-void residual once UTI symptoms have resolved.
In older men, in general, larger postvoid residual may be acceptable. Certainly postvoid residual greater than 50-75 ml can affect urinary function and is an indicator of underlying bladder problem.
Causes of Urinary Retention
The causes of urinary retention differ in men and women. The following are common causes of urinary retention in both men and women:
- Urethral cancer
- Bladder Cancer
- Radiation-induced urethral stricture
- Non-obstructive urinary retention due to the neurogenic bladder or detrusor areflexia
Urinary Retention in Women
In women, especially younger women, most commonly, causes of urinary retention are related to neurological diseases such as multiple sclerosis, diabetes, or medications.
In older women, bladder outlet obstruction from pelvic organ prolapse such as cystocele and uterine prolapse can lead to urinary tract obstruction and urinary retention. Neurological problems such as spinal cord injury, stroke, and multiple sclerosis can also lead to urinary retention in women. Occasionally cervical cancer or prior radiation to the pelvis can cause urethral obstruction and urinary retention.
Urinary Retention in Men
Urinary retention is much more common in men than in women. The causes of urinary retention in men include most of the causes of urinary retention in women including neurological problems such as multiple sclerosis, spinal cord injury, stroke, and medications.
In addition, in men especially starting around age 45-50, urinary retention tends to be caused by enlarged prostate due to BPH, prostate swelling due to infection, or poorly functioning bladder.
Treatment Options for Urinary Retention In New York
At New York Urology Specialists we offer advanced innovative treatment options for urinary retention in men and women.
- Clean intermittent catheterization, indwelling Foley catheterization.
- Advanced magnetic driven motorized artificial sphincter for women with urinary incontinence (Vesiflo Bladder Drainage)
- Sacral Neuromodulation with InterStim for Nonobstructive Urinary Retention
- Greenlight laser for enlarged prostate in men.
- Bipolar transurethral resection of the prostate for enlarged prostate in men
At New York Urology Specialists, we treat men and women from Brooklyn, Queens, Staten Island, Bronx and Manhattan for problems with urination and retention of urine. Our urinary retention specialists treat many men and women from New Jersey as well as international patients.
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men and women with urinary problems including frequent urination, difficulty emptying the bladder, urinary urgency and incontinence.
We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester and New Jersey as well as other parts of the USA. We also see international patients from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.