Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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To clearly define urinary retention, it is important to understand the anatomy of the lower urinary tract and how urination works. The bladder and urethra work together to store urine at low pressure and then release it efficiently when needed. This system acts like a hydraulic pump, controlled by nerves, muscles, and fluid movement. Unlike the heart, which works on its own, the bladder is under voluntary control and connects both automatic and conscious parts of the nervous system.
The Storage Phase: Physiology of Compliance and Accommodation
In healthy people, the bladder is very flexible and can hold more urine as it fills. Urine moves from the kidneys to the bladder at a normal rate, and the bladder muscle relaxes to let the bladder expand. This ability, called accommodation, lets the bladder hold up to 400-600 mL of urine without much increase in pressure. This protects the kidneys. If the pressure rose too much, urine could flow backward, causing kidney swelling and possible permanent damage.
As the bladder fills, tension receptors (mechanoreceptors) in the bladder wall send afferent signals via the Pelvic Nerve to the sacral spinal cord (S2-S4). This triggers a spinal reflex loop known as the “Guarding Reflex.” This reflex increases the somatic drive via the Pudendal Nerve to the External Urethral Sphincter (striated muscle), causing it to contract more tightly. This ensures that outlet resistance remains higher than bladder pressure, even during sudden increases in intra-abdominal pressure such as coughing, sneezing, or lifting (stress events).
Urination is more than just stopping storage; it is a complex reflex controlled by the brain and spinal cord. When you decide to urinate, a center in the brainstem called the Pontine Micturition Center takes over. It works with another area, the Periaqueductal Gray, which checks for safety before allowing urination to start.
Urinary Retention is fundamentally a failure of this hydrodynamic equation. It occurs when the Pump is too weak (Detrusor Failure/Acontractility) to generate enough pressure, or when the Pipe is too tight (Bladder Outlet Obstruction) for the Pump to overcome.
Urinary retention means you cannot urinate or fully empty your bladder on your own. It is not a disease itself, but a symptom caused by problems in the urinary tract, nervous system, or from certain medications. Doctors divide it into two types: acute (sudden and painful) and chronic (long-term and often painless).
This is a urological emergency requiring immediate intervention. It is defined as the sudden and painful inability to pass urine despite a full bladder.
This is a painless, insidious, and often progressive condition. It is defined by the presence of a substantial volume of urine remaining in the bladder after voiding (Post-Void Residual or PVR). While definitions vary in the literature, a PVR >300 mL persisting over time is a commonly accepted threshold at Liv Hospital.
The causes of retention are vast, spanning urology, neurology, and gynecology. They can be grouped into four mechanistic categories:
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Yes. Acute retention is extremely painful and can cause rupture of the bladder (though rare) or acute kidney injury due to back-pressure. Chronic retention is “silently” dangerous; because it is painless, it can persist for years, slowly destroying the kidneys (hydronephrosis) and leading to irreversible end-stage renal failure before it is detected.
Retention is the inability to empty the bladder (holding too much). Incontinence is the inability to hold urine (leaking). However, they often coexist in a condition called “Overflow Incontinence.” This happens when the bladder is so full (retention) that the pressure overcomes the sphincter, causing urine to spill out (incontinence), much like a glass of water overflowing when overfilled. This paradox (leaking because you are full) is often misdiagnosed as simple incontinence.
Yes, it is a widespread trigger, especially in the elderly and children (“Elimination Dysfunction Syndrome”). The rectum sits immediately behind the bladder and urethra. A rectum distended with hard stool physically compresses the urethra and the bladder neck, making it mechanically difficult to void. It also triggers a nerve reflex (rectovesical reflex) that inhibits bladder contraction.
PVR is the amount of urine left in the bladder immediately after you finish urinating. In a healthy bladder, this should be near zero (or less than 50 mL). In urinary retention, the PVR is elevated (often >300 mL). Ultrasound is the key diagnostic test for PVR.
Yes. Stagnant urine acting like a “pool of still water” allows bacteria to multiply rapidly, leading to frequent and severe infections. If left untreated, this bacteria can travel upward from the bladder to the kidneys, causing a dangerous systemic infection known as Urosepsis.
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Acute urinary retention is a condition where people suddenly can’t empty their bladder. It affects millions worldwide, greatly impacting their quality of life.retention definitionUrinary Retention:
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Urinary retention is when your body can’t fully empty the bladder. It affects millions of people worldwide. It’s a medical emergency that needs quick attention.
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