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Last reviewed: 14 Mar 2025
Last updated: 13 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • signs of early organ dysfunction (tachypnea, tachycardia, hypotension, altered mental state) in a patient with suspected sepsis
  • flank pain
  • fever
  • lower urinary tract symptoms
  • distended abdomen/palpable bladder
  • inability to urinate
  • enlarged or hard nodular prostate on rectal examination
  • costovertebral angle tenderness
  • neurological disease (e.g., spinal cord injury, multiple sclerosis)

Other diagnostic factors

  • haematuria
  • increasing age
  • meatal narrowing
  • pelvic or abdominal malignancy
  • previous urethral instrumentation
  • urinary tract infection in a child
  • pelvic mass on internal examination
  • weight loss and lymphadenopathy
  • recurrent urinary tract infections
  • urinary incontinence

Risk factors

  • benign prostatic hyperplasia (BPH)
  • constipation
  • medication (anticholinergic agents, opioid analgesics, alpha receptor agonists)
  • urolithiasis (ureteric calculi)
  • spinal cord injury, Parkinson's disease, or multiple sclerosis
  • malignancy
  • pregnancy
  • haematuria
  • posterior urethral valves
  • bladder hernia
  • cystocele
  • iatrogenic injury
  • urethral instrumentation
  • retroperitoneal fibrosis
  • meatal stenosis

Diagnostic investigations

1st investigations to order

  • urinary dipstick
  • renal ultrasound
  • urea and creatinine
  • FBC
  • CT abdomen and pelvis without contrast

Investigations to consider

  • urine culture
  • blood culture
  • CT scan abdomen and pelvis without and with contrast
  • magnetic resonance urography (MRU)
  • intravenous pyelogram (excretory urography)
  • nuclear renography (triple renal/MAG3 scan)
  • voiding cystourethrogram
  • bladder ultrasound
  • prostate specific antigen
  • tumour markers (e.g., serum serum carcinoembryonic antigen [CEA], CA125)

Treatment algorithm

Contributors

Authors

Harris E. Foster Jr., MD

Professor of Urology

Section Chief of Lower Urinary Tract Dysfunction and Reconstruction

Yale School of Medicine

New Haven

CT

Disclosures

HEF declares that he has no competing interests.

Adam Benjamin Hittelman, MD, PhD

Associate Professor in Urology

Section Chief of Pediatric Urology

Yale School of Medicine

New Haven

CT

Disclosures

ABH declares that he has provided expert testimony and has given lectures on obstructive uropathy.

Parth M. Patel, MD

Assistant Professor of Urology

Department of Urology

University of California Los Angeles

Los Angeles

CA

Disclosures

PMP declares that he has no competing interests.

Acknowledgements

Harris E. Foster Jr., Adam Benjamin Hittelman, and Parth M. Patel would like to gratefully acknowledge Adrienne J. Carmack, a previous contributor to this topic.

Disclosures

AJC declares that she has no competing interests.

Peer reviewers

Brian Cohen, MD

Private Practice Urologist

Asheville

NC

Disclosures

BC declares that he has no competing interests.

Yekutiel Sandman, MD

Private Practice Urologist

Miami

FL

Disclosures

YS declares that he has no competing interests.

Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital

Cambridge

UK

Disclosures

VG declares that he has no competing interests.

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