Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting context
Context and baseline
Time of onset and duration of retention symptoms
Acute complete inability to void
Partial voiding with progressive difficulty
Prior episodes
Baseline urinary function
Baseline post void residual if known
Symptom pattern and trajectory
Gradual worsening lower urinary tract symptoms
Sudden onset retention after trigger
Intermittent retention episodes
Postoperative course timing
Lower urinary tract symptoms
Obstructive symptoms
Hesitancy
Weak stream
Intermittency
Straining
Incomplete emptying sensation
Post void dribbling
Irritative symptoms
Frequency
Urgency
Nocturia
Dysuria
Suprapubic discomfort
OPQRST
Onset characterization
Sudden onset
Gradual onset
Post trigger timing
Provocation and palliation
Worse after alcohol intake
Worse after cold exposure
Worse after prolonged immobility
Triggered by constipation
Triggered by recent procedure
Improved after warm bath
Symptom quality
Suprapubic pressure
Suprapubic pain
Burning dysuria
Flank pain
Location and radiation
Suprapubic
Perineal
Flank
Groin radiation
Severity
Unable to void at all
Minimal dribbling only
Severe pain with distension
Mild discomfort with retention
Timing pattern
Constant inability to void
Episodic retention
Worse at night
Postoperative day association
Associated symptoms
Infectious and inflammatory
Fever
Chills
Rigors
Dysuria
Foul smelling urine
Hematuria
Renal colic and obstruction
Flank pain
Nausea
Vomiting
Gross hematuria
Neurologic
New back pain
Leg weakness
Saddle anesthesia
New fecal incontinence
New urinary incontinence overflow
Hemodynamic and systemic
Lightheadedness
Syncope
Confusion
Decreased oral intake
Urologic and gynecologic history
Male specific
Known benign prostatic hyperplasia
Prior prostate cancer treatment history
Prior urethral instrumentation
Erectile dysfunction medications
Female specific
Pregnancy status and postpartum status
Pelvic organ prolapse symptoms
Recent pelvic surgery
Vulvar or pelvic pain
Prior urologic conditions
Urethral stricture history
Prior urinary retention
Recurrent urinary tract infections
Nephrolithiasis history
Alarm Features
Immediate danger features
Escalation triggers
Sepsis concern
Fever with hypotension
Tachycardia with altered mental status
Acute kidney injury concern
Anuria
Oliguria with rising creatinine
Cauda equina syndrome concern
Urinary retention with saddle anesthesia
Urinary retention with new leg weakness
Obstructed infected system concern
Flank pain with fever
Flank pain with hypotension
Gross hematuria with clot retention
Inability to void with visible clots
Suprapubic distension with ongoing bleeding
Vital sign thresholds
High risk vitals
Systolic blood pressure < 90 mmHg
Heart rate > 120 bpm
Respiratory rate > 24 per minute
Temperature >= 38.0 C
Oxygen saturation < 92 percent
High risk contexts
High risk situations
Recent spinal trauma
Recent epidural or spinal anesthesia
Immunocompromised state
Pregnancy with acute retention
Solitary kidney with suspected obstruction
Known urologic malignancy
Medications
Medication causes of retention
Anticholinergic burden
Antihistamines
Tricyclic antidepressants
Antipsychotics
Antispasmodics
Parkinson medications with anticholinergic effect
Sympathomimetics
Decongestants
Amphetamines
Cocaine exposure history
Opioids and sedatives
Opioids
Benzodiazepines
Gabapentinoids
Other contributors
Calcium channel blockers
NSAIDs in volume depletion context
Diuretics with dehydration contribution
Medication history features
Medication use pattern
Recent new medication
Recent dose escalation
Recent perioperative medications
Over the counter cold products
Herbal supplements
Anticoagulants and bleeding risk
Warfarin
Direct oral anticoagulant
Antiplatelet therapy
Diet
Intake and exposures
Hydration and intake
Low fluid intake
Recent vomiting
Recent diarrhea
Triggers and exposures
Alcohol intake
Caffeine intake
Energy drink intake
Constipating diet pattern
Review of Systems
System symptom screen
Genitourinary
Dysuria
Frequency
Urgency
Nocturia
Hematuria
Incontinence overflow
Gastrointestinal
Constipation
Obstipation
Abdominal distension
Nausea
Vomiting
Neurologic
Back pain
Weakness
Numbness
Saddle anesthesia
Gait change
Infectious
Fever
Chills
Rigors
Recent infection symptoms
Cardiopulmonary
Chest pain
Dyspnea
Palpitations
Collateral History and Family History
Collateral and family patterns
Collateral inputs
Witnessed inability to void
Timeline confirmation
Baseline functional status
Family history
Prostate cancer
Kidney stones
Urologic malignancy
Risk Factors
Patient and exposure risk
Obstructive risk
Benign prostatic hyperplasia
Prostate cancer history
Urethral stricture history
Prior pelvic radiation
Neurologic risk
Diabetes mellitus with neuropathy (E11.9)
Multiple sclerosis (G35)
Spinal stenosis
Recent spinal trauma
Infectious risk
Recent urinary tract infection
Indwelling catheter history
Immunosuppression
Stone risk
Prior nephrolithiasis (N20.0)
Dehydration
Hypercalciuria history
Procedure and device risk
Recent surgery
Recent anesthesia
Recent urethral instrumentation
Pelvic organ prolapse history
Differential Diagnosis
Life threatening
Life threatening causes
Cauda equina syndrome (G83.4)
Urinary retention
Saddle anesthesia
New leg weakness
Sepsis from urinary source (A41.9)
Fever
Hypotension
Altered mental status
Obstructed infected urinary system
Flank pain
Fever
Hydronephrosis
Acute kidney injury from obstruction (N17.9)
Rising creatinine
Hyperkalemia
Gross hematuria with clot retention (R31.0)
Visible clots
Bladder distension
Common
Common causes
Benign prostatic hyperplasia related obstruction (N40.1)
Progressive obstructive symptoms
Enlarged prostate on exam
Constipation and fecal impaction (K59.00)
No bowel movement
Rectal vault stool
Medication induced urinary retention
Anticholinergic exposure
Opioid exposure
Urinary tract infection (N39.0)
Dysuria
Pyuria
Postoperative urinary retention
Recent surgery
Recent neuraxial anesthesia
Less common
Less common causes
Urethral stricture (N35.9)
Weak stream
Prior instrumentation history
Neurogenic bladder
Diabetes neuropathy
Spinal cord disease
Prostatitis (N41.0)
Perineal pain
Tender prostate
Bladder outlet obstruction from malignancy
Weight loss
Hematuria
Pelvic organ prolapse
Vaginal bulge symptoms
Post void retention sensation
Mimics and pitfalls
Mimics
Anuria from shock without retention
Empty bladder on scan
Hypotension
Pain limited voiding without true retention
Small post void residual
Severe dysuria
Functional retention
Anxiety context
Normal objective findings
Past Medical History
Relevant history clusters
Urologic history
Benign prostatic hyperplasia
Prior urinary retention episodes
Recurrent urinary tract infections
Nephrolithiasis
Urologic surgeries
Neurologic and endocrine
Diabetes mellitus
Multiple sclerosis
Prior stroke (I63.9)
Parkinson disease (G20)
Surgical and anesthesia history
Recent surgery type
Neuraxial anesthesia history
Pelvic surgery history
Baseline status
Baseline continence
Baseline mobility and sensation
Physical Exam
Vitals and general
General and hemodynamics
Mental status
Toxic appearance
Perfusion and hydration
Fever pattern
Abdominal and bladder
Suprapubic distension
Suprapubic tenderness
Peritoneal signs
Palpable bladder
Genitourinary exam
Male focused
Meatal stenosis
Phimosis
Testicular exam for pain source
Digital rectal exam
Prostate enlargement
Prostate tenderness
Female focused
Pelvic organ prolapse
Vulvar lesions
Pelvic tenderness
Neurologic and spine
Cauda equina screen
Lower extremity strength
Lower extremity sensation
Perineal sensation
Anal wink and tone
Back and spine
Midline tenderness
Radicular signs
Trauma stigmata
Skin and extremities
Volume status signs
Dry mucous membranes
Delayed capillary refill
Edema absence
Infection sources
Cellulitis
Perineal skin infection
Lab Studies
Core labs and interpretation
Basic evaluation
Urinalysis
Pyuria pattern
Hematuria pattern
Urine culture
Antibiotic tailoring value
Prior resistant organism history relevance
Creatinine and electrolytes
Acute kidney injury pattern
Hyperkalemia concern
CBC
Leukocytosis context
Anemia in hematuria context
Sepsis and systemic concern
Lactate
Elevated lactate supports hypoperfusion
Normal lactate does not exclude sepsis
Blood cultures
Prior to antibiotics when feasible
Higher yield in hypotension or rigors
Test pitfalls
Common limitations
Pyuria absent early in infection
Contaminated specimen after catheter insertion
Hematuria can be from catheter trauma
Imaging
Scoring Systems
Decision tools
Post void residual thresholds
> 300 mL suggests significant retention
> 500 mL supports acute retention in most contexts
Sepsis screening tools
qSOFA limited sensitivity
Use with clinical judgment
MRI
MRI spine
Cauda equina syndrome concern
Urinary retention with saddle anesthesia
Urinary retention with new weakness
Contraindications and delays
Non MRI compatible implant local protocol dependent
Need for transfer if unavailable local protocol dependent
CT
CT abdomen and pelvis
Urolithiasis with obstruction concern
Flank pain pattern
Hydronephrosis on ultrasound
CT with contrast considerations
Contrast allergy history
Renal function context
CT for malignancy concern
Hematuria workup pathway local protocol dependent
Pelvic mass concern local protocol dependent
Ultrasound
Bladder ultrasound
Post void residual estimate
Bladder distension confirmation
Foley balloon position check if poor drainage
Renal ultrasound
Hydronephrosis assessment
Obstructive pattern support
False negatives early obstruction
Special Tests
Bedside diagnostics
Bladder scan
Pre catheter volume estimation
Post catheter residual reassessment
Catheter passage test
Resistance at urethra suggests stricture
Blood at meatus suggests urethral injury
Rectal exam adjuncts
Fecal impaction confirmation
Anal tone assessment
Procedural diagnostics
Difficult catheter algorithm local protocol dependent
Coude catheter trial
Smaller caliber catheter trial
Urology consultation trigger
ECG
Indications and patterns
ECG indications
Hyperkalemia concern
Sepsis with hemodynamic instability
Chest pain or dyspnea concurrent
Hyperkalemia findings
Peaked T waves
PR prolongation
QRS widening
Assessment
Problem representation
Urinary retention severity
Acute complete retention
Chronic retention with overflow
Postoperative retention
Complications assessment
Acute kidney injury presence
Infection presence
Neurogenic red flags presence
Likely etiology stratification
Bladder outlet obstruction
Medication induced
Neurologic cause
Infectious inflammatory cause
Plan
First 5 minutes
Immediate stabilization
Cardiac monitor if unstable
IV access if sepsis concern
Fluids if hypovolemia and no contraindication
Broad spectrum antibiotics if sepsis suspected local protocol dependent
Bladder decompression
Catheterization pathway
Urethral Foley catheter
Initial 14 to 18 Fr typical adult size
Coude catheter if prostatic obstruction suspected
Drainage monitoring
Immediate urine output volume
Hematuria after insertion
Bladder decompression complications
Post obstructive diuresis monitoring
Hypotension after decompression uncommon
Etiology directed treatment
Benign prostatic hyperplasia suspected
Alpha blocker example
Tamsulosin PO 0.4 mg daily
Orthostatic hypotension risk
Trial of void timing local protocol dependent
2 to 3 days after alpha blocker start common practice
Earlier trial may fail
Urinary tract infection suspected
Antibiotics local protocol dependent
Tailor to local antibiogram
Adjust for renal function
Pyelonephritis or sepsis concern
Parenteral antibiotics local protocol dependent
Admission consideration
Constipation contribution
Disimpaction strategy local protocol dependent
Osmotic laxative example
Polyethylene glycol PO 17 g daily
Avoid if bowel obstruction concern
Cauda equina syndrome concern
Immediate MRI spine
Neurosurgery consultation emergent
Reassessment loop
Reassessment timing
Pain reassessment within 30 to 60 minutes
Urine output reassessment within 1 hour
Repeat bladder scan if poor catheter drainage
Post obstructive diuresis monitoring
Urine output > 200 mL per hour for 2 hours
Or > 3 L in 24 hours
Electrolytes every 4 to 6 hours if significant diuresis
Disposition
Level of care criteria
ICU criteria
Septic shock requiring vasopressors
Severe hyperkalemia with ECG changes
Rapid neurologic decline
Inpatient admission criteria
Obstructed infected system
Acute kidney injury requiring monitoring
Post obstructive diuresis requiring IV replacement
Gross hematuria with ongoing clot retention
Inability to catheterize with persistent retention
Observation pathway criteria
Postoperative retention without sepsis
Stable vitals with moderate retention and clear plan
Discharge criteria
Symptom control
Stable vitals
Clear catheter function or successful trial of void
Follow up arranged
Follow up timing
Urology follow up
Within 2 to 7 days if discharged with catheter
Earlier if difficult catheterization or hematuria
Primary care follow up
Medication review within 1 to 2 weeks
Constipation management follow up
Discharge Instructions
Copy discharge instructions
Summary
Urinary retention treated with bladder drainage
Cause not always clear on first visit
Catheter care
Keep catheter and bag below bladder level
Do not disconnect tubing unless instructed
Clean around catheter daily with soap and water
Medications
Take prescribed medications as directed
Avoid over the counter cold medicines that can worsen retention
Fluids and bowel care
Drink fluids unless told otherwise
Prevent constipation with fiber and stool softener if recommended
Return to ED now for
Fever
Shaking chills
New back pain with weakness or numbness
Catheter not draining for 2 to 3 hours with increasing pain
Large amounts of blood in urine
Severe pain not controlled
References
Guideline and evidence sources
Urologic retention and lower urinary tract symptoms guidance
American Urological Association guideline statements on BPH management local protocol dependent
European Association of Urology guidelines on non neurogenic male LUTS and BPH local protocol dependent
Neurogenic and spinal emergency guidance
Neurologic emergency references for cauda equina syndrome evaluation and MRI timing local protocol dependent
Spine society statements on emergent decompression timing local protocol dependent
Infection and sepsis guidance
Surviving Sepsis Campaign guidelines 2021
IDSA guidance for complicated urinary tract infection and pyelonephritis local protocol dependent
Diagnostic tool references
Evidence summaries for post void residual thresholds and bladder scan performance local protocol dependent
Imaging appropriateness criteria for suspected renal colic local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.