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Chronic Urinary Retention: Comparative Effectiveness and Harms of Treatments: Comparative Effectiveness Review Number 140

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Chronic Urinary Retention: Comparative Effectiveness and Harms of Treatments: Comparative Effectiveness Review Number 140

4.85 95,898 ratings · 8,189 reviews
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Overview: Persistent partial retention of urine or chronic urinary retention (CUR) is a common problem for which we have little understanding in terms of prevalence, natural history, prognosis, or efficacy and comparative effectiveness of treatments. Also unclear are whether and when to suspect, screen, or treat patients for CUR. Standard diagnostic criteria (including the duration and volume of post-void residual [PVR] urine necessary for a diagnosis) have not been established for chronic urinary retention. Researchers often define CUR as PVR urine volume greater than 300 ml; however, some studies define it as 100 ml, 400 ml, or 500 ml. CUR may be either asymptomatic or associated with lower urinary tract symptoms such as urinary frequency, urgency, or incontinence. Elevated PVR or CUR can increase risk for urinary tract infections (UTI) and renal failure. Some studies of men with lower urinary tract symptoms and CUR indicate increased risk of acute urinary retention (AUR), renal failure, and lower likelihood that benign prostatic hypertrophy surgery will improve urinary symptoms. A threshold PVR urine volume associated with these consequences is unclear, although negative outcomes have been demonstrated in men with PVR volumes over 500 ml. We do not know if these findings are applicable to asymptomatic CUR. CUR is almost always caused by another (often concomitant) medical condition. Causes of CUR are commonly categorized as obstructive or non-obstructive. In men, the most prevalent obstructive cause is bladder outlet obstruction associated with benign prostatic enlargement. As many as 25 percent of men who undergo prostate surgery for benign prostatic enlargement have CUR. Obstructive causes of CUR in women include complications from surgery for stress urinary incontinence and pelvic organ prolapse. In both sexes, urethral strictures and pelvic masses are obstructive causes. CUR not caused by obstruction is typically due to detrusor underactivity, which can be neurogenic (damage to nerves that innervate the bladder in conditions such as multiple sclerosis, spinal cord injury) or myogenic (damage to the smooth muscle of the bladder). An additional non-obstructive cause of CUR is Fowler’s syndrome, which affects mainly young women, is characterized by urinary retention due to a failure of urethral sphincter relaxation, and is not well recognized in the United States. The goal treatment is to improve function and/or quality of life and reduce complications to an extent meaningful to patients. Treatment and management options depend on etiology. Most approaches (including surgery, minimally invasive procedures, and drugs) address the underlying condition or mechanical cause (e.g., benign prostatic enlargement, neurogenic bladder) rather than specifically addressing CUR. When treatment fails to alleviate CUR, catheterization can be used for bladder management. Harms are specific to the interventions and may include infection and surgical complications. Our review addresses the following Key Key Question 1: What are the effectiveness and comparative effectiveness of treatments for chronic urinary retention in adults? a. With male-specific etiologies? b. With female-specific etiologies? c. With non sex-specific etiologies d. What patient or condition characteristics (e.g., age, severity, etc.) modify the effectiveness of treatment? Key Question 2: What are the harms and comparative harms of treatments for chronic urinary retention in adults? a. With male-specific etiologies? b. With female-specific etiologies? c. With non sex-specific etiologies? d. What patient or condition characteristics (e.g., age, severity, etc.) modify the harms of treatment?

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Agency for Healthcare Research and Quality (AHRQ) writes contemporary fiction and has always been fascinated by character-driven stories. They hold a degree in English Literature and previously worked as an editor before transitioning to writing their own books. Agency for Healthcare Research and Quality (AHRQ) lives with their spouse and a very vocal rescue cat.

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A highly sophisticated read. The protagonist was compelling, though some subplots felt slightly overshadowed. Quite impressive overall.
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Such a rich narrative. I became deeply invested in the protagonist's journey. A masterclass in storytelling. I am now a lifelong fan of this author.
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Michelle Evans October 05, 2024
Masterpiece from start to finish. The author orchestrated a breathtaking finale. Truly a work of art. Worth every moment spent reading.
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Exceeded all my expectations. I became deeply invested in the protagonist's journey. A masterclass in storytelling. I am now a lifelong fan of this author.
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I was completely blown away. I became deeply invested in the protagonist's journey. A masterclass in storytelling. An absolute must-read for connoisseurs of the genre.
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Exceeded all my expectations. The author orchestrated a breathtaking finale. Truly a work of art. An absolute must-read for connoisseurs of the genre.
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An acceptable diversion. It possessed moments of brilliance, but the narrative felt slightly disjointed ultimately. Unlikely to reread, but a reasonable expenditure of time.
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I was completely blown away. It strikes a perfect harmony of dialogue and world-building. Every chapter felt necessary. Worth every moment spent reading.
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An acceptable diversion. It possessed moments of brilliance, but the narrative felt slightly disjointed ultimately. Perhaps more aligned with a different audience's tastes.
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Honestly one of the most premium reading experiences lately. I adored how the story unfolded. It kept me captivated without sacrificing elegance. A true literary gem.
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Not entirely to my refined tastes. The tempo was somewhat languid, and I found my mind wandering. Not poor, simply average. Unlikely to reread, but a reasonable expenditure of time.
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Honestly one of the most premium reading experiences lately. I adored how the story unfolded. It kept me captivated without sacrificing elegance. Worth every moment spent reading.
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I thoroughly enjoyed the elegance of it. It held my rapt attention, even when certain twists were telegraphed. A very distinguished novel.
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A profoundly satisfying read. The pacing was impeccable and the characters felt incredibly authentic. I was completely immersed. An effortless 5 stars.
Melissa Moore
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I thoroughly enjoyed the elegance of it. A brilliant concept executed with flair. Just a few pacing choices I would change. I would highly recommend this to discerning readers.
George Hall
George Hall August 07, 2024
I was completely blown away. I adored how the story unfolded. It kept me captivated without sacrificing elegance. I will undoubtedly revisit this masterpiece.
Amanda Ramirez
Amanda Ramirez August 13, 2024
Honestly one of the most premium reading experiences lately. The prose is exquisite. It’s accessible yet undeniably sophisticated. I am now a lifelong fan of this author.
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Honestly one of the most premium reading experiences lately. I adored how the story unfolded. It kept me captivated without sacrificing elegance. An effortless 5 stars.
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Stephanie Flores March 19, 2024
Absolutely brilliant. I became deeply invested in the protagonist's journey. A masterclass in storytelling. I will undoubtedly revisit this masterpiece.
Michelle Williams
Michelle Williams November 08, 2024
Absolutely brilliant. The author orchestrated a breathtaking finale. Truly a work of art. Worth every moment spent reading.
Michael Turner
Michael Turner September 15, 2024
Took a moment to build, but the payoff was spectacular. A brilliant concept executed with flair. Just a few pacing choices I would change. A solid 4 stars from me.
Nancy Brown
Nancy Brown May 16, 2025
A highly sophisticated read. The protagonist was compelling, though some subplots felt slightly overshadowed. A solid 4 stars from me.
Kevin Sanchez
Kevin Sanchez February 07, 2025
A profoundly satisfying read. I adored how the story unfolded. It kept me captivated without sacrificing elegance. An effortless 5 stars.
Emily Evans
Emily Evans February 16, 2025
Exceeded all my expectations. It strikes a perfect harmony of dialogue and world-building. Every chapter felt necessary. I will undoubtedly revisit this masterpiece.
James Clark
James Clark March 01, 2024
Masterpiece from start to finish. The prose is exquisite. It’s accessible yet undeniably sophisticated. An absolute must-read for connoisseurs of the genre.
Melissa Robinson
Melissa Robinson December 21, 2025
A profoundly satisfying read. The pacing was impeccable and the characters felt incredibly authentic. I was completely immersed. An absolute must-read for connoisseurs of the genre.
Donald Jackson
Donald Jackson November 11, 2024
A very strong entry. Beautiful writing, though I craved slightly more depth in the lore. Still, undeniably engaging. A wonderful companion for a quiet weekend.
Andrew Garcia
Andrew Garcia November 10, 2024
Took a moment to build, but the payoff was spectacular. The protagonist was compelling, though some subplots felt slightly overshadowed. A wonderful companion for a quiet weekend.
Linda Garcia
Linda Garcia December 15, 2025
A decent, if standard, experience. It verged on repetitive in the second act. A more concise edit would have served it well. Unlikely to reread, but a reasonable expenditure of time.
Eric Flores
Eric Flores January 20, 2025
Took a moment to build, but the payoff was spectacular. A brilliant concept executed with flair. Just a few pacing choices I would change. Quite impressive overall.
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