# Urinary retention - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class US04 - condition scope only, no dose · Male Urinary Retention: Acute and Chronic - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538499/ · Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20) - Verified date: 2026-08 ## Verified against - Urinary retention - disease-level clinical article (urinary-retention-full.txt) - Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20) ## Treatment metadata - Tamsulosin — 0.4 mg — oral.solid - Referral & safety-netting (no drug therapy) - Finasteride — 5 mg — oral.solid ## Complete treatment card ```text URINARY RETENTION Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class US04 - condition scope only, no dose · Male Urinary Retention: Acute and Chronic - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538499/ · Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20) Review status: REVIEWED against Urinary retention - disease-level clinical article (urinary- retention-full.txt), Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Lower abdominal pain paired with an inability to pass urine marks acute retention [abdominal pain · lower abdominal pain · urinary retention] - The urine stream may be reduced to a trickle or stop altogether in acute retention [urinary retention] - Small-volume leakage can occur alongside chronic retention as overflow incontinence [urinary retention] - Needing to void again shortly after finishing (double voiding) suggests chronic retention [urinary retention] - Trouble starting the stream is a hesitancy symptom of chronic retention [poor urinary stream · urinary retention] - A persistently slow or weak stream is another chronic-retention symptom [poor urinary stream · urinary retention] SIGNS - what you find (2) - A distended bladder may be palpable on abdominal exam [urinary retention] - Digital rectal exam can reveal prostate enlargement, fecal impaction, or poor sphincter tone pointing to a cord problem TESTS (5) - A post-void residual over 200 mL is abnormal, and over 400 mL usually confirms retention - An AUA symptom score of 10 or higher means BPH treatment should be started, changed, or stepped up - Hydronephrosis on both sides on renal ultrasound strongly points to chronic retention - Renal ultrasound is ordered for a residual over 1500 mL or newly found renal failure - Placing a Foley catheter right away is both diagnostic and treatment in an obvious case IF NOT THIS - what else fits (4) - Detrusor-sphincter dyssynergia is a neurologic differential for retention - Retroperitoneal fibrosis can compress the ureters or bladder outlet and mimic retention - Bilateral renal calculi occurring at the same time are on the differential - Chronic kidney disease should be considered in the differential for retention Source StatPearls "Male Urinary Retention: Acute and Chronic" - disease-level clinical article Status traced to the source above Rx: Alpha-blocker | Main treatment | 5-alpha reductase inhibitor ALPHA-BLOCKER 1. TAMSULOSIN [1st line] Adult 0.4 mg once daily, modified-release capsule; the article allows up to 0.8 mg - Start at the time of catheterisation; it needs 72 hours for full effect, and continues afterwards Peds Not a paediatric drug. Retention in a child is a different problem with different causes and belongs with a paediatric surgeon or urologist. Choice Alternatives. All the alpha-blockers work equally well at equivalent doses, so the choice is about side effects and what the pharmacy has: tamsulosin and alfuzosin can be started at the full dose, doxazosin and terazosin have to be titrated and drop the blood pressure more. Source Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20) Why THE CATHETER COMES FIRST - the cited article puts immediate bladder decompression with a 16-French Foley ahead of any drug, and says rapid complete drainage is best even for a very large bladder. The drug is what makes the catheter removable. The article names alpha-blockade as the primary first-line medical therapy for retention caused by benign prostatic enlargement, especially over 60, and says a man in acute retention who is not already on one should be started on one, and a man already on one should have the dose maximised. The formulary's tamsulosin monograph names benign prostatic hyperplasia as its indication and gives 0.4 mg daily as the modified-release capsule dose. Caution THE DRUG DOES NOT EMPTY THE BLADDER. Catheterise first. If the urethra cannot be passed - and after recent prostatectomy or urethral reconstruction it must not be attempted - a suprapubic tube is needed urgently. IT TAKES 72 HOURS to reach full effect, which is why the trial of voiding is not attempted before then. The formulary states plainly that tamsulosin is NOT indicated for hypertension. It still drops the blood pressure on standing, particularly with the first dose and in the elderly. Warn any man due for cataract surgery, and tell his ophthalmologist: alpha-blockers cause intraoperative floppy iris syndrome, and the surgeon must know before the operation, not after. DO NOT GIVE PROPHYLACTIC ANTIBIOTICS with the catheter. The article is explicit that they have been shown not to prevent infection and drive resistance. Treat an infection only if there is one. Alfuzosin 10 mg daily and silodosin 4-8 mg daily are the equally effective alternatives in the article. Doxazosin and terazosin work as well but drop the standing blood pressure more and have to be titrated up, so the article does not recommend them for acute retention. Egypt NORMIRAMA 0.4 MG 30 CAPS. EGPI > RAMAPH... 60.00 EGP (2.00/unit) TAMSUNORM S.R. 0.4MG 30 CAPS. RAMEDA 60.00 EGP (2.00/unit) TAMSULOSIN 0.4 MG 20 CAPS. GLAXO SMITHKL... 42.00 EGP (2.10/unit) CUREPRO XR 0.4 MG 30 CAPS. DEBEIKY > KHU... 105.00 EGP (3.50/unit) BLOCK ALPHA 0.4 MG MR 30 CAPS. ADWIA 120.00 EGP (4.00/unit) FIRAMAZIN 0.4MG 30 H.G.CAPS. EVA PHARMA 54.00 EGP OMNIC 0.4MG 30 MODIFIED RELEASE CAPS. ASTELLAS PHARMA > MULTIPHARMA 147.00 EGP OMNIC OCAS 0.4 MG 30 PROLONGED RELEASE F.C.TAB. ASTELLAS PHARMA INC > MU... 282.00 EGP MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Common in older men with prostate enlargement; the GP recognises acute retention, may attempt catheterisation or refer, and starts medication for underlying benign prostate enlargement. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Common in older men with prostate enlargement; the GP recognises acute retention, may attempt catheterisation or refer, and starts medication for underlying benign prostate enlargement. Caution Acute painful urinary retention is a urological emergency needing prompt catheterisation and referral. The referral is urological and it still stands. The alpha-blocker above is the exception: it is started in primary care at the time of catheterisation, because it is what decides whether the catheter can come out. RED FLAG - Urinary retention accompanied by back pain, sciatica, lower extremity weakness, saddle anesthesia, or bowel dysfunction indicates cauda equina syndrome requiring immediate MRI and emergency surgical evaluation. RED FLAG - Large post-void residual urine volumes (>1500 mL), acute renal failure, or electrolyte imbalances carry high risk for post-obstructive diuresis requiring hospital admission. 5-ALPHA REDUCTASE INHIBITOR - give alongside 3. FINASTERIDE [add-on - not a substitute] Adult 5 mg once daily - At least 6 months for full effect; over a year to reduce future retention and surgery Peds Not a paediatric drug. Source Male Urinary Retention: Acute and Chronic - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538499/ Why This is prevention, not treatment of the episode in front of you. The cited article says finasteride or dutasteride shrinks the prostate by about 20-25% and lowers the chance of a further episode of acute retention, but needs at least 6 months to work and helps most where the prostate is over 30 g. Added as an adjunct beside the alpha-blocker, never instead of it. Caution IT DOES NOTHING FOR THE EPISODE IN FRONT OF YOU. Six months to full effect. The catheter and the alpha-blocker are what relieve today's retention. IT HALVES THE PSA. The article notes a roughly 50% reduction; a PSA taken on finasteride has to be doubled before it is interpreted, or a prostate cancer is missed. A woman who is or may become pregnant must not handle crushed or broken tablets - the drug harms a male fetus. Warn about the sexual side effects before starting, not after: reduced libido, erectile difficulty and reduced ejaculate. Egypt MIXOSTERIDE 5 MG 14 F.C. TAB. SIGMA > PHARM... 30.00 EGP (2.14/unit) FINCAR 5MG 10 F.C. TAB. RAMEDA 26.40 EGP (2.64/unit) PROSTAT 5MG 14 F.C. TABS. CID > OCTOBER... 46.00 EGP (3.29/unit) PROSTEC 5 MG 14 F.C.TAB. SIGMA 47.00 EGP (3.36/unit) FINASTURA 5MG 30 F.C.TAB. GLOBAL NAPI P... 111.00 EGP (3.70/unit) ROYALSTERIDE 5 MG 30 F.C. TABS. HI-PHARM > RO... 132.00 EGP (4.40/unit) PROSTRIDE 5MG 30 CAPS. ADWIA 183.00 EGP (6.10/unit) PROSCAR 5MG 28 F.C. TAB. MERCK SHARP &... 258.00 EGP (9.21/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)