Management of urinary retention in palliative care

Management of urinary retention depends on the cause. Consider the potential benefits and burdens of each intervention, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Assess for and manage any treatable causes of urinary retention.

Acute urinary retention requires prompt urinary catheterisation. For patients with chronic urinary retention, a catheter is needed if the patient has overflow incontinence, kidney failure or infection.

A trial of void may be appropriate; timing of the trial should allow for recovery of bladder tone. For patients with a large residual urine volume, the catheter should not be removed immediately after drainage because the bladder will have been stretched, making recurrence of urinary retention likely. If removal of the catheter is considered, it should be done after 1 to 2 weeks to give the bladder time to recover.

If urinary catheterisation is not possible (eg because of a urethral stricture), or if long-term catheterisation is contemplated, suprapubic catheterisation may be required.