Last reviewed: 25 Sep 2021
Last updated: 09 Feb 2021

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
  • neurologic disease (e.g., spinal cord injury, multiple sclerosis)

Other diagnostic factors

  • hematuria
  • 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, narcotic analgesia, alpha receptor agonists)
  • urolithiasis (ureteric calculi)
  • spinal cord injury, Parkinson disease, or multiple sclerosis
  • malignancy
  • pregnancy
  • hematuria
  • posterior urethral valves
  • bladder hernia
  • cystocele
  • iatrogenic injury
  • urethral instrumentation
  • retroperitoneal fibrosis
  • meatal stenosis

Diagnostic investigations

1st investigations to order

  • urinary dipstick
  • renal ultrasound
  • serum BUN and creatinine
  • CBC
  • CT pyelogram
  • intravenous pyelogram (excretory urography)

Investigations to consider

  • urine culture
  • blood culture
  • CT scan abdomen and pelvis
  • magnetic resonance urography
  • nuclear renography (triple renal/MAG3 scan)
  • voiding cystourethrogram
  • bladder ultrasound
  • prostate specific antigen
  • tumor markers (e.g., serum carcinoembryonic antigen [CEA], CA125)

Treatment algorithm

Contributors

Authors

Adrienne J. Carmack, MD

Urologist

Integrative Health Matters

Tyler 

TX

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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