Urinary Retention in Kids

Originally published at Pediatric EM Morsels on Nov. 4, 2020. Reposted with permission.

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Once again the Ped EM Morsels will address a topic that accentuates the fact that children are not aliens to be feared, but rather a special population of humans. Yes, children can be afflicted with conditions traditionally considered in adults (ex, Pulmonary EmbolismA-Fib, and Kidney Stones), but kids will often have different risk factors and associated conditions. Another entity that fits this description I encountered just this week. Let’s take a minute to review (what I had to review) on Urinary Retention in Kids:

Urinary Retention: Basics

  • Urinary retention is uncommon in children.
  • It is defined as a volume of retained urine > expected bladder capacity
    • Estimated Bladder Capacity in Ounces = Age in years + 2 [Gatti, 2001; Peter, 1993]
      • Remember Fluid Ounce = ~ 30 mL
    • Not defined by duration from last urination
  • Child may present with:
    • Dribbling or urine
    • Weak stream
    • Unable to initiate bladder emptying
    • Abdominal pain
    • Palpable abdominal mass (bladder above pubic bone)

Urinary Retention: Causes in Kids

  • Infection
    • One of the most common causes [Peter, 1993]
    • Examples: Cystitis, Pyelonephritis
    • Systemic viral illnesses also implicated (ex, adenovirus, EBV) [Chu, 2013; Gatti, 2001]
  • Neuromuscular Dysfunction
    • Are a prevalent cause in children. [Gatti, 2001]
    • Acute Disseminated Encephalitis (ADEM) [Burla, 2016]
      • Presents with paresthesias, paralysis, ataxia, vision changes, and/or altered mental status.
      • Often preceded by viral illness or vaccine administration.
    • Other examples: Guillain-Barre Syndrome, Multiple Sclerosis, Transverse Myelitis, Spina Bifida, Tethered cord [Burla, 2016; Gatti, 2001; Peter, 1993]
  • Congenital Obstructive Lesions
    • Examples: Posterior urethral valves, Polyps [Peter, 1993]
  • Constipation
    • Yup… that is a lot of stool!
    • Thought to be due to marked elevation of the bladder floor and posterior urethra by the distended rectum. [Gatti, 2001; Peter, 1993]
  • Medications
    • Adverse drug effects are very commonly implicated. [Gatti, 2001]
    • ex, Cold medications, antihistamines, neuroleptics, alpha-adrenergic agonists
  • Postoperative
  • Renal Stones
  • Misc.
    • Hypermagnesemia (newborn exposed to maternal Magnesium)
    • Voluntary overdistention [Peter, 1993]
      • Potty training may lead to avoiding urination, leading to increased bladder volume.
      • Stretching of the bladder beyond its normal capacity impairs its elastic properties and can hinder voiding.
    • Pelvic masses [Binder, 2015; Gatti, 2001]
    • Local inflammatory processes [Gatti, 2001]
      • Meatal stenosis, balanoposthitis, labial adhesions
    • Peri-apendiceal Abscess [Parrish, 1993]
    • Incarcerated inguinal hernia [Gatti, 2001]
  • See Table 1 below, courtesy of Binder et al., 2015

Urinary Retention: Management

  • Drain the bladder!
    • If the belief is that the cause is temporary (ex, constipation, voluntary overdistention), then may consider in-and-out cath to decompress bladder.
    • If unsure, or concern for other neurologic condition, place foley.
    • If not using a foley, patient will need to demonstrate ability to void on her/his own before discharge.
    • Children with UTIs may be instructed to soak in bath of warm water to help with urination (obviously, this is at their home… not your ED).
  • Check for infection!
    • This is a prevalent cause, so don’t overlook UTI.
    • At the same time, don’t be too eager to diagnose UTI and overlook other more ominous signs.
  • Perform a thorough Neuro Exam!
    • Of greatest concern – is there a spinal cord or other neurologic condition that is the cause?
    • Inspect the back carefully… look for evidence of occult spinal abnormalities.
    • If a clear reason is not obvious, have a low threshold for considering spinal imaging. [Gatti, 2001]
  • What’s the Anatomy?
    • Even those who have a UTI, may have it because of an anatomic abnormality.
    • Consider Ultrasound:
      • Evaluate for hydronephrosis
      • Evaluate for masses
      • If not getting U/S in ED, ensure follow-up to consider imaging.

Moral of the Morsel

  • It may be rare, but it does happen. As always, remain vigilant.
  • Urinary retention is ominous. Don’t simply send the child home with a foley and a leg bag like you may do for the old gentleman with prostate problems.

Ddx of Urinary Retention

Differential Diagnosis of Urinary Retention in Children[Binder, 2015]


Binder Z1, Iwata K1, Mojica M2, Ginsburg HB3, Henning J1, Strubel N4, Kahn P5. Acute Urinary Retention Caused by an Ovarian Teratoma-A Unique Pediatric Presentation and Review. J Emerg Med. 2015 Nov;49(5):e139-42. PMID: 26275742[PubMed] [Read by QxMD]

Heckmann R1, de la Fuente FA1, Heiner JD2. Pediatric urinary retention and constipation: vaginal agenesis with hematometrocolpos. West J Emerg Med. 2015 May;16(3):418-9. PMID: 25987917[PubMed] [Read by QxMD]
Gatti JM1, Perez-Brayfield M, Kirsch AJ, Smith EA, Massad HC, Broecker BH. Acute urinary retention in children. J Urol. 2001 Mar;165(3):918-21. PMID: 11176514[PubMed] [Read by QxMD]

Parrish GA1, Wright GD, Falk JL. Acute urinary retention: an unusual presentation of appendiceal abscess. Ann Emerg Med. 1993 May;22(5):857-60. PMID: 8470845[PubMed] [Read by QxMD]

Peter JR1, Steinhardt GF. Acute urinary retention in children. Pediatr Emerg Care. 1993 Aug;9(4):205-7. PMID: 8367356[PubMed] [Read by QxMD]

Nishimoto N, Kajikawa J, Miyoshi S, Iwao N, Mizutani S, Okuyama A. Urinary retention secondary to ovarian dysgerminoma in a girl. Urology. 1985 Jul;26(1):71-3. PMID: 4012986[PubMed] [Read by QxMD]

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