Chronic urinary retention (CUR) Emergency Medicine handbook
Definition
Chronic urinary retention (CUR) is a long‑standing inability to empty the bladder completely, with persistent elevated post‑void residual (PVR) urine. It develops over weeks to months and is distinct from acute urinary retention (AUR), which is an inability to pass urine and usually requires immediate decompression.
Why it matters in the ED
CUR may be clinically silent until complications arise (recurrent urinary tract infections, overflow incontinence, hydronephrosis or renal impairment). Emergency priorities are to recognise retention, exclude renal compromise or infection, provide safe decompression when indicated, and arrange appropriate follow‑up or urgent urology referral.
Epidemiology and common causes
- The commonest cause is bladder outlet obstruction from benign prostatic hyperplasia (BPH), accounting for about half of cases (≈50-55%) (NICE CG97).
- Other causes include urethral stricture and bladder neck obstruction from surgical or radiation scarring.
- Neurogenic bladder (diabetes, spinal injury or other neurologic disease) is an important cause.
- Medications that impair detrusor contractility (anticholinergics, opioids) can cause or worsen CUR.
- Pelvic organ prolapse is a common cause in women.
- Functional causes include immobility and cognitive impairment.
Pathophysiology
Chronic outlet obstruction leads to detrusor hypertrophy and increased bladder pressure initially. Over time detrusor decompensation reduces contractility and bladder compliance, producing high PVR and increasing the risk of upper‑tract dilation and obstructive nephropathy.