GPAtlas🧭 When to suspect
Chronic urinary retention (CUR) is the gradual, painless inability to empty the bladder completely, developing over months or years. The hallmark is a non-painful bladder that remains palpable or percussible after voiding, or a post-void residual (PVR) volume > 1 litre on imaging. It is easily missed because it is often asymptomatic or presents only with mild lower urinary tract symptoms (LUTS) – or, deceptively, with overflow incontinence in a man thought to have an "overactive bladder".
The single most important task in primary care is to decide which of two very different conditions you are dealing with, because management diverges completely. This rests almost entirely on the U&Es and the renal tract ultrasound.
| Feature | Low-pressure CUR | High-pressure CUR |
|---|---|---|
| Renal function | Normal | Impaired (raised creatinine / falling eGFR) |
| Upper tracts on ultrasound | No hydronephrosis | Hydronephrosis, often bilateral |
| Nocturnal enuresis | Uncommon | Characteristic (the give-away) |
| Risk | Low – essentially benign | High – progressive, irreversible renal failure |
| Action | Treat LUTS; routine catheter not required | Urgent decompression and specialist referral |
Raise suspicion in older men with BPH (the commonest cause), and in anyone with a neurogenic bladder (diabetic autonomic neuropathy, spinal disease, multiple sclerosis, Parkinson's), urethral stricture, or a high anticholinergic / opioid burden. CUR is largely a male condition but has an appreciable background incidence in women, usually from pelvic organ prolapse or neurological disease.
Source: NICE CG97
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