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Urinary Retention

National Kidney and Urologic Diseases Information Clearinghouse

What is urinary retention? What is the urinary tract

Urinary retention is the inability to andhow does it work?
empty the bladder completely. Urinary The urinary tract is the bodys drainage
retention can be acute or chronic. Acute system for removing urine, which is
urinary retention happens suddenly and composed of wastes and extra fluid. In
lasts only a short time. People with acute order for normal urination to occur, all
urinary retention cannot urinate at all, body parts in the urinary tract need to work
even though they have a full bladder. together in the correct order.
Acute urinary retention, a potentially
life-threatening medical condition, Kidneys. The kidneys are two bean-shaped
requires immediate emergency treatment. organs, each about the size of a fist. They
Acute urinary retention can cause great are located just below the rib cage, one
discomfort or pain. on each side of the spine. Every day, the
kidneys filter about 120 to 150 quarts of
Chronic urinary retention can be a long- blood to produce about 1 to 2 quarts of
lasting medical condition. People with urine. The kidneys work around the clock;
chronic urinary retention can urinate. a person does not control what they do.
However, they do not completely empty
all of the urine from their bladders. Ureters. Ureters are the thin tubes of
Often people are not even aware they muscleone on each side of the bladder
have this condition until they develop that carry urine from each of the kidneys to
another problem, such as urinary the bladder.
incontinenceloss of bladder control, Bladder. The bladder, located in the pelvis
resulting in the accidental loss of urine between the pelvic bones, is a hollow,
or a urinary tract infection (UTI), muscular, balloon-shaped organ that
an illness caused by harmful bacteria expands as it fills with urine. Although a
growing in the urinary tract. person does not control kidney function,
a person does control when the bladder
empties. Bladder emptying is known as
urination. The bladder stores urine until
the person finds an appropriate time and
place to urinate. A normal bladder acts
like a reservoir and can hold 1.5 to 2 cups bladder is the bladder neck. The bladder
of urine. How often a person needs to neck, composed of the second set of
urinate depends on how quickly the kidneys muscles known as the internal sphincter,
produce the urine that fills the bladder. helps urine stay in the bladder. The third
The muscles of the bladder wall remain set of muscles is the pelvic floor muscles,
relaxed while the bladder fills with urine. also referred to as the external sphincter,
As the bladder fills to capacity, signals which surround and support the urethra.
sent to the brain tell a person to find a
To urinate, the brain signals the muscular
toilet soon. During urination, the bladder
bladder wall to tighten, squeezing urine
empties through the urethra, located at the
out of the bladder. At the same time,
bottom of the bladder.
the brain signals the sphincters to relax.
Three sets of muscles work together like a As the sphincters relax, urine exits the
dam, keeping urine in the bladder. bladder through the urethra.
The first set is the muscles of the urethra
itself. The area where the urethra joins the






Male and female urinary tracts

2Urinary Retention
What causes urinary phase of growth begins around age 25and
continues during most of a mans life.
retention? Benign prostatic hyperplasia often occurs
Urinary retention can result from with the second phase of growth.
obstruction of the urethra As the prostate enlarges, the gland presses
nerve problems against and pinches the urethra. The
bladder wall becomes thicker. Eventually,
medications the bladder may weaken and lose the ability
weakened bladder muscles to empty completely, leaving some urine in
the bladder.
Obstruction of the Urethra
Read more in Prostate Enlargement:
Obstruction of the urethra causes urinary
Benign Prostatic Hyperplasia at
retention by blocking the normal urine
flow out of the body. Conditions such as
benign prostatic hyperplasiaalso called Urethral stricture. A urethral stricture
BPHurethral stricture, urinary tract is a narrowing or closure of the urethra.
stones, cystocele, rectocele, constipation, Causes of urethral stricture include
and certain tumors and cancers can cause inflammation and scar tissue from surgery,
an obstruction. disease, recurring UTIs, or injury. In
men, a urethral stricture may result from
Benign prostatic hyperplasia. For men
prostatitis, scarring after an injury to the
in their 50s and 60s, urinary retention is
penis or perineum, or surgery for benign
often caused by prostate enlargement due
prostatic hyperplasia and prostate cancer.
to benign prostatic hyperplasia. Benign
Prostatitis is a frequently painful condition
prostatic hyperplasia is a medical condition
that involves inflammation of the prostate
in which the prostate gland is enlarged and
and sometimes the areas around the
not cancerous. The prostate is a walnut-
prostate. The perineum is the area between
shaped gland that is part of the male
the anus and the sex organs. Since men
reproductive system. The gland surrounds
have a longer urethra than women, urethral
the urethra at the neck of the bladder.
stricture is more common in men than
The bladder neck is the area where the
urethra joins the bladder. The prostate
goes through two main periods of growth. Read more in Prostatitis: Inflammation of
The first occurs early in puberty, when the Prostate at www.urologic.niddk.nih.gov.
the prostate doubles in size. The second

1Urethral stricture. Mayo Clinic website.

Updated November 20, 2012. Accessed April 1, 2014.

3Urinary Retention
Surgery to correct pelvic organ prolapse, Rectocele. A rectocele is a bulging of the
such as cystocele and rectocele, and urinary rectum into the vagina. A rectocele occurs
incontinence can also cause urethral when the muscles and supportive tissues
stricture. The urethral stricture often gets between a womans rectum and vagina
better a few weeks after surgery. weaken and stretch, letting the rectum sag
from its normal position and bulge into
Urethral stricture and acute or chronic
the vagina. The abnormal position of the
urinary retention may occur when the
rectum may cause it to press against and
muscles surrounding the urethra do not
pinch the urethra.
relax. This condition happens mostly in
women. Constipation. Constipation is a condition
in which a person has fewer than three
Urinary tract stones. Urinary tract stones
bowel movements a week or has bowel
develop from crystals that form in the urine
movements with stools that are hard, dry,
and build up on the inner surfaces of the
and small, making them painful or difficult
kidneys, ureters, or bladder. The stones
to pass. A person with constipation may
formed or lodged in the bladder may block
feel bloated or have pain in the abdomen
the opening to the urethra.
the area between the chest and hips. Some
Cystocele. A cystocele is a bulging of the people with constipation often have to
bladder into the vagina. A cystocele occurs strain to have a bowel movement. Hard
when the muscles and supportive tissues stools in the rectum may push against the
between a womans bladder and vagina bladder and urethra, causing the urethra
weaken and stretch, letting the bladder sag to be pinched, especially if a rectocele is
from its normal position and bulge into present.
the vagina. The abnormal position of the
Read more in Constipation at
bladder may cause it to press against and
pinch the urethra.
Tumors and cancers. Tumors and
Read more in Cystocele at
cancerous tissues in the bladder or urethra
can gradually expand and obstruct urine
flow by pressing against and pinching the
urethra or by blocking the bladder outlet.
Tumors may be cancerous or noncancerous.

4Urinary Retention
Nerve Problems Many patients have urinary retention right
Urinary retention can result from problems after surgery. During surgery, anesthesia
with the nerves that control the bladder is often used to block pain signals in the
and sphincters. Many events or conditions nerves, and fluid is given intravenously to
can interfere with nerve signals between compensate for possible blood loss. The
the brain and the bladder and sphincters. combination of anesthesia and intravenous
If the nerves are damaged, the brain may (IV) fluid may result in a full bladder with
not get the signal that the bladder is full. impaired nerve function, causing urinary
Even when a person has a full bladder, the retention. Normal bladder nerve function
bladder muscles that squeeze urine out may usually returns once anesthesia wears off.
not get the signal to push, or the sphincters The patient will then be able to empty the
may not get the signal to relax. People bladder completely.
of all ages can have nerve problems that Medications
interfere with bladder function. Some of
the most common causes of nerve problems Various classes of medications can cause
include urinary retention by interfering with nerve
signals to the bladder and prostate. These
vaginal childbirth medications include
brain or spinal cord infections or antihistamines to treat allergies
cetirizine (Zyrtec)
chlorpheniramine (Chlor-Trimeton)
diphenhydramine (Benadryl)
multiple sclerosis
fexofenadine (Allegra)
pelvic injury or trauma
anticholinergics/antispasmodics to
heavy metal poisoning treat stomach cramps, muscle spasms,
In addition, some children are born with and urinary incontinence
defects that affect the coordination of nerve hyoscyamine (Levbid)
signals among the bladder, spinal cord, and
brain. Spina bifida and other birth defects oxybutynin (Ditropan)
that affect the spinal cord can lead to propantheline (Pro-Banthine)
urinary retention in newborns.
tolterodine (Detrol)
Read more in Nerve Disease and Bladder
Control and Urine Blockage in Newborns at

5Urinary Retention
tricyclic antidepressants to treat Over-the-counter cold and allergy
anxiety and depression medications that contain decongestants,
such as pseudoephedrine, and
amitriptyline (Elavil)
antihistamines, such as diphenhydramine,
doxepin (Adapin) can increase symptoms of urinary retention
imipramine (Tofranil) in men with prostate enlargement.

nortriptyline (Pamelor) Weakened Bladder Muscles

Other medications associated with urinary Aging is a common cause of weakened
retention include bladder muscles. Weakened bladder
muscles may not contract strongly enough
decongestants or long enough to empty the bladder
ephedrine completely, resulting in urinary retention.

How common is urinary
nifedipine (Procardia), a medication Urinary retention in men becomes more
to treat high blood pressure and chest common with age.
In men 40 to 83 years old, the overall
carbamazepine (Tegretol), a
incidence of urinary retention is 4.5 to
medication to control seizures in
6.8 per 1,000 men.2
people with epilepsy
For men in their 70s, the overall
cyclobenzaprine (Flexeril), a muscle
incidence increases to 100 per
relaxant medication
1,000 men.2
diazepam (Valium), a medication used
For men in their 80s, the incidence
to relieve anxiety, muscle spasms, and
of acute urinary retention is 300 per
1,000 men.2
nonsteroidal anti-inflammatory drugs
opioid analgesics

2Selius BA, Subedi R. Urinary retention in adults:

diagnosis and initial management. American Family

Physician. 2008;77(5):643650.

6Urinary Retention
Urinary retention in women is less feeling the need to urinate after
common, though not rare.3 The incidence finishing urination
of urinary retention in women has not
mild and constant discomfort in the
been well studied because researchers have
lower abdomen and urinary tract
primarily thought of urinary retention as a
mans problem related to the prostate.4 Some people with chronic urinary retention
may not have symptoms that lead them to
seek medical care. People who are unaware
What are the symptoms they have chronic urinary retention
ofurinary retention? may have a higher chance of developing
The symptoms of acute urinary retention complications.
may include the following and require
immediate medical attention:
inability to urinate When to Seek Medical
painful, urgent need to urinate Care
pain or discomfort in the lower A person who has any of the following
abdomen symptoms should see a health care
bloating of the lower abdomen provider right away:

The symptoms of chronic urinary retention complete inability to urinate

may include great discomfort or pain in the
urinary frequencyurination eight or lower abdomen and urinary tract
more times a day
trouble beginning a urine stream
a weak or an interrupted urine stream
an urgent need to urinate with little
success when trying to urinate

3Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-

Walsh Urology. 10th ed. Philadelphia: Saunders; 2011.
4Mevcha A, Drake MJ. Etiology and management of

urinary retention in women. Indian Journal of Urology.


7Urinary Retention
How is urinary retention providers office, a radiology center, or a
hospital, and a radiologista doctor who
diagnosed? specializes in medical imaginginterprets
A health care provider diagnoses acute or the images. The patient does not need
chronic urinary retention with anesthesia.
a physical exam A health care provider may use a
postvoid residual measurement cathetera thin, flexible tubeto measure
postvoid residual. The health care provider
A health care provider may use the inserts the catheter through the urethra
following medical tests to help determine into the bladder, a procedure called
the cause of urinary retention: catheterization, to drain and measure the
cystoscopy amount of remaining urine. A postvoid
residual of 100 mL or more indicates the
computerized tomography (CT) scans bladder does not empty completely. A
urodynamic tests health care provider performs this test
during an office visit. The patient often
receives local anesthesia.
Physical Exam
Medical Tests
A health care provider may suspect urinary
retention because of a patients symptoms Cystoscopy. Cystoscopy is a procedure that
and, therefore, perform a physical exam requires a tubelike instrument, called a
of the lower abdomen. The health care cystoscope, to look inside the urethra and
provider may be able to feel a distended bladder. A health care provider performs
bladder by lightly tapping on the lower belly. cystoscopy during an office visit or in an
outpatient center or a hospital. The patient
Postvoid Residual Measurement will receive local anesthesia. However,
in some cases, the patient may receive
This test measures the amount of urine
sedation and regional or general anesthesia.
left in the bladder after urination. The
A health care provider may use cystoscopy
remaining urine is called the postvoid
to diagnose urethral stricture or look for a
residual. A specially trained technician
bladder stone blocking the opening of the
performs an ultrasound, which uses
harmless sound waves to create a picture
of the bladder, to measure the postvoid Read more in Cystoscopy and Ureteroscopy
residual. The technician performs the at www.urologic.niddk.nih.gov.
bladder ultrasound in a health care

8Urinary Retention
CT scans. CT scans use a combination of provider will perform these tests during an
x rays and computer technology to create office visit. For tests that use a catheter, the
images. For a CT scan, a health care patient often receives local anesthesia.
provider may give the patient a solution
Uroflowmetry. Uroflowmetry
to drink and an injection of a special dye,
measures urine speed and volume.
called contrast medium. CT scans require
Special equipment automatically
the patient to lie on a table that slides into
measures the amount of urine and the
a tunnel-shaped device where a technician
flow ratehow fast urine comes out.
takes the x rays. An x-ray technician
Uroflowmetry equipment includes
performs the procedure in an outpatient
a device for catching and measuring
center or a hospital, and a radiologist
urine and a computer to record the
interprets the images. The patient does not
data. The equipment creates a graph
need anesthesia. A health care provider
that shows changes in flow rate from
may give infants and children a sedative to
second to second so the health care
help them fall asleep for the test. CT scans
provider can see the highest flow
can show
rate and how many seconds it takes
urinary tract stones to get there. A weak bladder muscle
or blocked urine flow will yield an
abnormal test result.
Pressure flow study. A pressure flow
traumatic injuries study measures the bladder pressure
abnormal, fluid-containing sacs called required to urinate and the flow rate
cysts a given pressure generates. A health
care provider places a catheter with
Urodynamic tests. Urodynamic tests a manometer into the bladder. The
include a variety of procedures that look manometer measures bladder pressure
at how well the bladder and urethra store and flow rate as the bladder empties.
and release urine. A health care provider A pressure flow study helps diagnose
may use one or more urodynamic tests to bladder outlet obstruction.
diagnose urinary retention. The health care

9Urinary Retention
Video urodynamics. This test uses How is urinary retention
xrays or ultrasound to create real-time
images of the bladder and urethra
during the filling or emptying of the A health care provider treats urinary
bladder. For x rays, a health care retention with
provider passes a catheter through bladder drainage
the urethra into the bladder. He or
she fills the bladder with contrast urethral dilation
medium, which is visible on the video urethral stents
images. Video urodynamic images can
show the size and shape of the urinary prostate medications
tract, the flow of urine, and causes of surgery
urinary retention, such as bladder neck
The type and length of treatment depend
on the type and cause of urinary retention.
Read more in Urodynamic Testing at
www.urologic.niddk.nih.gov. Bladder Drainage
Bladder drainage involves catheterization
Electromyography. Electromyography uses
to drain urine. Treatment of acute urinary
special sensors to measure the electrical
retention begins with catheterization
activity of the muscles and nerves in and
to relieve the immediate distress of
around the bladder and sphincters. A
a full bladder and prevent bladder
specially trained technician places sensors
damage. A health care provider performs
on the skin near the urethra and rectum
catheterization during an office visit or in
or on a urethral or rectal catheter. The
an outpatient center or a hospital. The
sensors record, on a machine, muscle and
patient often receives local anesthesia. The
nerve activity. The patterns of the nerve
health care provider can pass a catheter
impulses show whether the messages
through the urethra into the bladder. In
sent to the bladder and sphincters
cases of a blocked urethra, he or she can
coordinate correctly. A technician
pass a catheter directly through the lower
performs electromyography in a health
abdomen, just above the pubic bone,
care providers office, an outpatient center,
directly into the bladder. In these cases, the
or a hospital. The patient does not need
health care provider will use anesthesia.
anesthesia if the technician uses sensors
placed on the skin. The patient will
receive local anesthesia if the technician
uses sensors placed on a urethral or rectal

10Urinary Retention
For chronic urinary retention, the patient Prostate Medications
may require intermittentoccasional, Medications that stop the growth of or
or not continuousor long-term shrink the prostate or relieve urinary
catheterization if other treatments do retention symptoms associated with benign
not work. Patients who need to continue prostatic hyperplasia include
intermittent catheterization will receive
instruction regarding how to self- dutasteride (Avodart)
catheterize to drain urine as necessary. finasteride (Proscar)
Urethral Dilation The following medications relax the
Urethral dilation treats urethral stricture muscles of the bladder outlet and prostate
by inserting increasingly wider tubes into to help relieve blockage:
the urethra to widen the stricture. An alfuzosin (Uroxatral)
alternative dilation method involves
inflating a small balloon at the end of a doxazosin (Cardura)
catheter inside the urethra. A health care silodosin (Rapaflo)
provider performs a urethral dilation during
an office visit or in an outpatient center or tadalafil (Cialis)
a hospital. The patient will receive local tamsulosin (Flomax)
anesthesia. In some cases, the patient will
terazosin (Hytrin)
receive sedation and regional anesthesia.
Urethral Stents
Prostate surgery. To treat urinary retention
Another treatment for urethral stricture caused by benign prostatic hyperplasia, a
involves inserting an artificial tube, called urologista doctor who specializes in the
a stent, into the urethra to the area of urinary tractmay surgically destroy or
the stricture. Once in place, the stent remove enlarged prostate tissue by using
expands like a spring and pushes back the the transurethral method. For transurethral
surrounding tissue, widening the urethra. surgery, the urologist inserts a catheter or
Stents may be temporary or permanent. surgical instruments through the urethra
A health care provider performs stent to reach the prostate. Removal of the
placement during an office visit or in an enlarged tissue usually relieves the blockage
outpatient center or a hospital. The patient and urinary retention caused by benign
will receive local anesthesia. In some prostatic hyperplasia. A urologist performs
cases, the patient will receive sedation and some procedures on an outpatient basis.
regional anesthesia. Some men may require a hospital stay. In

11Urinary Retention
some cases, the urologist will remove the other pelvic organs. The urologist places
entire prostate using open surgery. Men stitches in the tissue to close up the defect
will receive general anesthesia and have a and then closes the incision in the vaginal
longer hospital stay than for other surgical wall with more stitches, removing any extra
procedures. Men will also have a longer tissue. These stitches tighten the layers of
rehabilitation period for open surgery. tissue that separate the organs, creating
more support for the pelvic organs. A
Read more in Prostate Enlargement:
urologist or gynecologista doctor who
Benign Prostatic Hyperplasia at
specializes in the female reproductive
systemperforms the surgery to repair
Internal urethrotomy. A urologist can a cystocele or rectocele in a hospital.
repair a urethral stricture by performing an Women will receive anesthesia.
internal urethrotomy. For this procedure,
Tumor and cancer surgery. Removal of
the urologist inserts a special catheter into
tumors and cancerous tissues in the bladder
the urethra until it reaches the stricture.
or urethra may reduce urethral obstruction
The urologist then uses a knife or laser to
and urinary retention.
make an incision that opens the stricture.
The urologist performs an internal
urethrotomy in an outpatient center or a What are the complications
hospital. The patient will receive general of urinary retention and its
anesthesia. treatments?
Cystocele or rectocele repair. Women Complications of urinary retention and its
may need surgery to lift a fallen bladder treatments may include
or rectum into its normal position. The
most common procedure for cystocele and UTIs
rectocele repair involves a urologist, who bladder damage
also specializes in the female reproductive
kidney damage
system, making an incision in the wall of the
vagina. Through the incision, the urologist urinary incontinence after prostate,
looks for a defect or hole in the tissue that tumor, or cancer surgery
normally separates the vagina from the

12Urinary Retention
UTIs. Urine is normally sterile, and the How can urinary retention
normal flow of urine usually prevents
bacteria from infecting the urinary tract.
be prevented?
With urinary retention, the abnormal urine People can prevent urinary retention before
flow gives bacteria at the opening of the it occurs by treating some of the potential
urethra a chance to infect the urinary tract. causes. For example, men with benign
prostatic hyperplasia should take prostate
Bladder damage. If the bladder becomes medications as prescribed by their health
stretched too far or for long periods, the care provider. Men with benign prostatic
muscles may be permanently damaged and hyperplasia should avoid medications
lose their ability to contract. associated with urinary retention, such
Kidney damage. In some people, urinary as over-the-counter cold and allergy
retention causes urine to flow backward medications that contain decongestants.
into the kidneys. This backward flow, called Women with mild cystocele or rectocele
reflux, may damage or scar the kidneys. may prevent urinary retention by doing
exercises to strengthen the pelvic muscles.
Urinary incontinence after prostate, tumor, In most cases, dietary and lifestyle changes
or cancer surgery. Transurethral surgery will help prevent urinary retention caused
to treat benign prostatic hyperplasia may by constipation. People whose constipation
result in urinary incontinence in some men. continues should see a health care provider.
This problem is often temporary. Most
men recover their bladder control in a few Read more about exercises to strengthen
weeks or months after surgery. Surgery to the pelvic muscles in Kegel Exercise Tips at
remove tumors or cancerous tissue in the www.urologic.niddk.nih.gov.
bladder, prostate, or urethra may also result
in urinary incontinence. Eating, Diet, and Nutrition
Researchers have not found that eating,
diet, and nutrition play a role in causing or
preventing urinary retention.

13Urinary Retention
Points to Remember A health care provider diagnoses
acute or chronic urinary retention
Urinary retention is the inability to
empty the bladder completely.
a physical exam
Urinary retention can be acute or
chronic. postvoid residual measurement
Urinary retention can result from A health care provider may use
the following medical tests to help
obstruction of the urethra
determine the cause of urinary
nerve problems retention:
medications cystoscopy
weakened bladder muscles computerized tomography (CT)
The symptoms of acute urinary scans
retention may include the following urodynamic tests
and require immediate medical
A health care provider treats urinary
inability to urinate
retention with
painful, urgent need to urinate
bladder drainage
pain or discomfort in the lower
urethral dilation
urethral stents
bloating of the lower abdomen
prostate medications
The symptoms of chronic urinary
retention may include surgery
urinary frequencyurination eight Complications of urinary retention
or more times a day and its treatments may include
trouble beginning a urine stream urinary tract infections (UTIs)
a weak or an interrupted urine bladder damage
stream kidney damage
an urgent need to urinate with urinary incontinence after
little success when trying to urinate prostate, tumor, or cancer surgery
feeling the need to urinate after People can prevent urinary retention
finishing urination before it occurs by treating some of
mild and constant discomfort in the potential causes.
the lower abdomen and urinary

14Urinary Retention
Hope through Research Society of Urologic Nurses and Associates
East Holly Avenue, Box 56
The National Institute of Diabetes and
Pitman, NJ 080710056
Digestive and Kidney Diseases (NIDDK)
Phone: 1888TAPSUNA
conducts and supports research into many
kinds of urinary tract disorders, including
Email: suna@ajj.com
urinary retention. The knowledge gained
Internet: www.suna.org
from these studies is advancing scientific
understanding of why urinary tract disorders Urology Care Foundation
develop, leading to improved methods of 1000 Corporate Boulevard
diagnosing, treating, and preventing them. Linthicum, MD 21090
Phone: 18008287866 or 4106893700
Clinical trials are research studies involving
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people. Clinical trials look at safe and
Email: info@urologycarefoundation.org
effective new ways to prevent, detect, or
Internet: www.UrologyHealth.org
treat disease. Researchers also use clinical
trials to look at other aspects of care, such For information about bladder, prostate,
as improving the quality of life for people and urethral cancer, contact the
with chronic illnesses. To learn more about
National Cancer Institute
clinical trials, why they matter, and how to
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participate, visit the NIH Clinical Research
9609 Medical Center Drive
Trials and You website at www.nih.gov/
Bethesda, MD 20892
health/clinicaltrials. For information about
Phone: 18004CANCER
current studies, visit www.ClinicalTrials.gov.
Internet: www.cancer.gov
For More Information
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at Kingston, Ontario. Anthony J. Schaeffer,
Internet: www.americanprostatesociety.com
M.D., Northwestern University, reviewed
the updated version of this publication.

15Urinary Retention
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