Management Of Acute Urinary Retention Research Articles

Efficacy of GreenLight laser prostatectomy in urinary retention.

The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention (UR). We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or GreenLight laser prostatectomy. CUR was defined as PVR >300 mL in males able to void and initial catheter drainage >1000 mL in males unable to void in the absence of pain. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The UR group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The UR group had a significantly higher age and a significantly higher postoperative catheterization time compared to the LUTS cohort. The CUR subgroup had a significantly higher PVR at one, three, and six months compared to the AUR subgroup, although other outcome measures were similar between the two cohorts. During three- and six-month followup visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months postoperative, the LUTS group had a higher catheter-free rate than the UR group (p=0.001). The successful first trial of void (TOV) rate for the UR and LUTS groups were 83% and 80%, respectively. At 12-month followup, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively. GreenLight laser prostatectomy is an effective and durable treatment for UR, with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

Editorial Comment.

No AccessJournal of UrologyAdult Urology16 Jun 2023Editorial CommentThis article comments on the following:Early vs Delayed Transurethral Surgery in Acute Urinary Retention: Does Timing Make a Difference? Timothy J. Burns and Peter J. Gilling Timothy J. BurnsTimothy J. Burns Department of Urology, Tauranga Hospital, Tauranga, New Zealand More articles by this author and Peter J. GillingPeter J. Gilling Department of Urology, Tauranga Hospital, Tauranga, New Zealand University of Auckland, Auckland, New Zealand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003559.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCES 1. Consequences of SARS-CoV-2 pandemic on urological surgery in France: a nationwide analysis of the healthcare system database. BMJ Open. 2022; 12(11):e066220-e066220. Crossref, Medline, Google Scholar 2. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2011; 109(1):88-95. Crossref, Medline, Google Scholar 3. . Early vs delayed transurethral surgery in acute urinary retention: does timing make a difference?J Urol. 2023; 210(3):000-000. Google Scholar Submitted November 11, 2022; accepted May 15, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology30 May 2023Early vs Delayed Transurethral Surgery in Acute Urinary Retention: Does Timing Make a Difference? Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy J. Burns Department of Urology, Tauranga Hospital, Tauranga, New Zealand More articles by this author Peter J. Gilling Department of Urology, Tauranga Hospital, Tauranga, New Zealand University of Auckland, Auckland, New Zealand More articles by this author Expand All Submitted November 11, 2022; accepted May 15, 2023; published 000. Advertisement PDF downloadLoading ...

The Evaluation and Management of Acute Urinary Retention in Elderly Male patients

Background: Urinary retention is a common urologicalemergency characterized by sudden inability to pass urinedespite having a full bladder, which may or may not beassociated with abdominal pain.Objective: The aim of this retrospective study is to documentthe prevalence, risk factors, management and outcomes ofacute urinary retention in geriatric male patients.Materials and Methods: Medical records of all patients whohad acute urinary retention treated at Urology Center Khost,from January 2018 to April 2020 were retrospectively reviewed.A total of 181 patients who had acute urinary retention wereincluded in this study. The demographic information, etiologyand treatment methods were collected and analyzed.Results: The average age ranged from 47 to 89 years withmedian age of 73. A total of 68 out of 181 patients presentingwith acute urinary retention were previously diagnosed withBPH history of 1 year 15 patients (21%), 5 years 33 patients(48%), >10 years 20 patients (31%). The rest of 113 patientswere categorized as having newly diagnosed BPH (54 cases)48%, urethral stricture owing to STD (4 cases) 3.5%, historyof penile trauma (2 cases) 1.7%, occlusion due to urethraland bladder stone (2 cases) 1.7%, bladder carcinoma (1case) 1%, neurologic disorder (stroke, spinal cord lesion anddiabetic neuropathy) 62 cases (53%), neurogenic bladder 7cases (6.2%). Urinary tract infection was exclusively foundin majority of the cases. Over all in 93% of the patients, thesymptoms resolved with successful bladder decompressionthrough urethral catheterization, 7% of the patients with difficultcatheterization, drainage was achieved by suprapubic bladdercatheterization under local anesthesia.Conclusions: This study suggests that the incidence rate ofacute urinary retention is directly related to the efforts madein primary prevention of acute urinary retention in high riskpatients. Acute urinary retention in BPH cases was moreevident in age group of ≥65 years. The most commonly usedinitial management for acute urinary retention was by carryingout bladder decompression via urethral catheterization, andsuprapubic catheter only being used in failures.

Efficacy and safety of clean intermittent catheterization in management of acute urinary retention: A multicenter prospective randomized trial

Efficacy and safety of clean intermittent catheterization in management of acute urinary retention: A multicenter prospective randomized trial

Эффективность и безопасность интермиттирующей катетеризации для купирования острой задержки мочи: проспективное сравнительное рандомизированное исследование

of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events.129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently.Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed.Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) - within 2 days, and in 13 (50%) - within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patients age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I.Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patients social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.

The Management of Acute Urinary Retention

A 54-year-old male with diabetes presents to the emergency room with 5 days of abdominal distension and pain. He is tachycardic but afebrile. Physical examination reveals a severely distended, though non–tender, abdomen and an enlarged prostate. No focal neurologic deficits are appreciated. Laboratory results show a leukocytosis of 18.1 K/mm3, a lactate of 4.9 mmol/L, and a potassium of 6.6 mmol/L. Serum creatinine is 10.4 mg/dL with an eGFR of 5 mL/min/1.73 m2. There is nephrotic range proteinuria on urinalysis. Vitamin B12 levels are normal and his hemoglobin A1c is 5.6%. Prostate-specific antigen is 0.93 ng/mL.

Acute urinary retention.

Acute urinary retention is a common clinical presentation in emergency departments in the UK and is responsible for over 30 000 hospital admissions annually. Awareness of the latest advice and guidelines regarding its presentation, investigation and management is paramount to improve patient outcomes and reduce morbidity. Immediate management of acute urinary retention relies on timely bladder decompression by catheterisation. Knowledge of the routes and types of catheterisation, including the associated risks, complications and contraindications, is essential to allow rapid and early intervention, thus preventing further complications. Differences in the presentation of patients with acute urinary retention reflect varying aetiologies, the knowledge of which determines long-term management and prognosis.

Best nonsurgical managements of acute urinary retention: what's new?

To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.

Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study.

Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). The aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e., age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59 [IQR 52-74] vs. 99 [IQR 74-125] mL, P=0.008) and a thinner BWT (5[IQR 4.8-5.2] vs. 5.2 [4.7-5.5] mm P=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11 (14%) vs. 33 (52%), P=0.001. On multivariate analysis, IPP<10mm (OR 6.10 [95%CI 2.61-14.20], P=0.001), lower IPSS (OR 0.95 [95% CI 0.89-0.99], P=0.045), smaller TRUS (OR 0.96 [95% CI 0.95-0.97], P=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) P=0.001were the independent predictors of voiding recovery. Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.

Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study.

BACKGROUND Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). Aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. METHODS A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e.age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. RESULTS Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59(IQR 52-74) Vs 99 (IQR 74-125) ml, p=0.008) and a thinner BWT (5(IQR 4.8-5.2) Vs 5.2 (4.7-5.5) mm p=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11(14%) vs 33(52%), p=0.001. On multivariate analysis, IPP<10mm (OR 6.10 (95%CI 2.61-14.20), p=0.001), lower IPSS (OR 0.95 (95%CI 0.89-0.99), p= 0.045), smaller TRUS (OR 0.96 (95%CI 0.95-0.97), p=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) p=0.001were the independent predictors of voiding recovery. CONCLUSIONS Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.

Effect of tamsulosin on testis histopathology and serum hormones in adult rats: Experimental study.

Background Tamsulosin is an inhibitory factor of alpha-adrenergic receptors that is used for relieving of the clinical symptoms and management of acute urinary retention.ObjectiveThe aim of this study was to evaluate the effects of tamsulosin on the endocrine axis and testicular tissue in adult male rats.Materials and MethodsIn this experimental study, 30 adult male Wistar rats (weighing 250-300 gr) were divided into three groups: 1) control (received distilled water), 2) experimental 1 (received 0.2 mg/kg/day tamsulosin) and 3) experimental 2 (received 0.4 mg/kg/day tamsulosin) through oral gavage for 28 days. Serum hormones level and testicular histopathology were evaluated at the end of the experiment.ResultsIn this study, the testicular weight decreased significantly in the experimental groups compared to the control group. A significant decrease was seen in testicular weight (p = 0.004) and the number of Leydig cells in tamsulosin-treated groups (p = 0.012). Tamsulosin improved the hormone profile in experimental groups. Also, higher dose of tamsulosin significantly changed the number of Leydig, spermatogonia cells, the thickness of germinal layer, and the diameter of the seminiferous tubules.Conclusion Results showed that using tamsulosin, possibly reduces the testosterone concentration through adrenergic axis system and in turn has destructive effects on proliferative activity of germ cells.

133 Prospective Audit of Adherence to Current Guidelines for Urinary Catheterisation on a Dedicated Geriatric ward in a Tertiary Hospital

Abstract Background A review of current practice in urinary catheterisation of geriatric patients on admission to hospital in respect of current HSE guidelines; looking at adherence to prescribed indications. Methods A consecutive sample of inpatients (age &gt;65 years) were included from a geriatric ward in a tertiary hospital. Medical notes and admission pro-forma were reviewed. Relevant demographic and clinical information was extrapolated and analysed descriptively using the Statistical Package for the Social Sciences software. Results Data from thirty-one patients was included. Mean age of the cohort was 81.58 years (SD=6.67) and 51.6% (n=16) were female (SD=6.67). The primary reasons for admission were increased care needs (n=6, 19.4%), and collapse/weakness (n=6, 19.4%), thereafter stroke (n=4, 12.9%). Urinary catheters were inserted in 45.2% (n=14); for output monitoring (n=4, 28.57%), diuresis (n=4, 28.57%) and management of acute urinary retention (n=3, 21.42%). The insertion was warranted as per guidelines in only 42.85% (n=6); for urinary retention (n=3, 21.42%), sepsis/ICU (n=2, 14.28%) and at patient's request for comfort (n=1,7.14%). Urinary incontinence was present in 25.8% (n=8). This was found to be poorly documented in medical admission notes (n=2, 6.5%). Mean hospital admissions in the previous twelve months was 1.61 (SD=2.20) and mean urinary tract infection in the same timeframe was 1.00 (SD=1.57). Trial without catheter was unsuccessful in 3.2% (n=1). Healthcare associated infection was recorded in 6.5% of cases (n=2). Conclusion Although this audit represents a small cohort, the results demonstrate a high rate of urinary catheter insertion without adequate indication. This audit should be repeated using a larger sample size. Appropriate education at ward level and with admitting NCHDs about: appropriate catheterisation practice should be performed with a view to re-auditing subsequently. Update of current guidelines is warranted.

PD19-01 DETRUSOR WALL THICKNESS DOES NOT PREDICT A SUCCESSFUL TRIAL WITHOUT CATHETER AFTER ACUTE URINARY RETENTION IN PATIENTS ON MEDICAL TREATMENT FOR BENIGN PROSTATIC HYPERPLASIA

INTRODUCTION AND OBJECTIVES:Alpha-blockers are considered the standard treatment for the management of acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH). However, no...

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common cause of morbidity in older men in developed countries. BPH causes lower urinary tract symptoms (LUTS) and occasionally results in such complications as acute urinary retention (AUR), urinary tract infection, and even obstructive uropathy. Although the development of medical treatments has reduced the role of surgery, prostatectomy remains a widely performed procedure. Epidemiology, risk factors, and pathophysiology are discussed. Diagnosis includes clinical features, history, physical examination, and laboratory testing. Management can include watchful waiting, medical treatment, surgery, and minimally invasive treatment. Management of AUR is also addressed. This review contains 4 figures, 10 tables, and 58 references. Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, urinary retention, incontinence, alpha blocker, 5α-reductase inhibitor, cystoscopy, transurethral intervention

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common cause of morbidity in older men in developed countries. BPH causes lower urinary tract symptoms (LUTS) and occasionally results in such complications as acute urinary retention (AUR), urinary tract infection, and even obstructive uropathy. Although the development of medical treatments has reduced the role of surgery, prostatectomy remains a widely performed procedure. Epidemiology, risk factors, and pathophysiology are discussed. Diagnosis includes clinical features, history, physical examination, and laboratory testing. Management can include watchful waiting, medical treatment, surgery, and minimally invasive treatment. Management of AUR is also addressed. This review contains 4 figures, 10 tables, and 58 references. Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, urinary retention, incontinence, alpha blocker, 5α-reductase inhibitor, cystoscopy, transurethral intervention

Evaluation of the impact of a clinical pathway on the progression of acute urinary retention.

The management of acute urinary retention (AUR) revolves around trial without catheter (TWOC) after prescription of an alpha-blocker. This study evaluates the implementation of a clinical pathway for AUR. Specific clinical pathways for AUR was established between the Emergency Department and the Department of Urology in order to reduce the duration of bladder drainage that included standard prescriptions, an information sheet, and a note to be faxed to scheduling nurses to organize the trial without catheter (TWOC). The main endpoint was the reduction in the time between the AUR episode and TWOC, without decreasing urination. Between April 2015 and December 2016, 248 patients were treated in the Emergency Department, and externally, for AUR. One hundred and seventy patients were enrolled in the pathway group and 78 in the control group. The mean duration of urinary catheterization decreased by 5.5 days as did the number of patients lost to follow-up (32% vs 76%), without decreasing the successful voiding (46% vs 36%). The duration of the urinary catheterization was not related to the chance of successful voiding regardless of the urine volume and a drainage time of over 10 days significantly reduced the chance of success (68%, n = 26 versus 42%, n = 76; P = 0.0038). The implementation of a clinical pathway for AUR reduced the number of patients lost to follow-up and the catheterization duration, thus optimizing the management of these patients.

Assessment of efficacy of silodosin in the management of acute urinary retention: A prospective study at a tertiary care hospital of northern India

Assessment of efficacy of silodosin in the management of acute urinary retention: A prospective study at a tertiary care hospital of northern India

Predictive variables of spontaneous micturition recovery after acute urinary retention in men with benign prostatic enlargement: An observational prospective study.

Acute urinary retention (AUR) is the sudden and painful inability to urinate spontaneously. AUR is one of the most significant complications of benign prostatic enlargement. The management of AUR is based on transurethral catheterization. Subsequent therapy is uncertain, but AUR seems to benefit from the use of alpha-blockers. The aim of this study was to evaluate the variables that could predict which patients would recover spontaneous micturition after trial without catheter. The present prospective observational study included men with AUR in an Italian tertiary care institute in 2016. Patients were catheterized and treated orally with fluoroquinolones, alpha-blockers, and Serenoa repens extracts. Preoperative variables as age, C-reactive protein (CRP), previous prostate-specific antigen values, urinary retention volume, prostate volume, and scores on a modified International Prostate Symptom Score questionnaire (IPSS-4), were investigated in relation to spontaneous micturition recovery. Mean (±SD) age was 68.4 ± 7.1 years. Spontaneous and valid micturition recovery was observed in 11 patients (29.7%), whereas 26 (70.3%) needed to be catheterized again. The IPSS-4 score was significantly lower (9 vs 17; P < .001) and CRP values were significantly higher (43.00 vs 1.00 mg/dL; P < .001) in patients who recovered spontaneous micturition. The IPSS-4 scores and CRP showed an area under the curve of 0.85 and 0.87, respectively. for the prediction of spontaneous and valid micturition recovery. CRP and IPSS-4 could be useful tools to predict spontaneous micturition recovery after catheterization associated with medical therapy for AUR.

Comparison of the delta neutrophil index with procalcitonin, erythrocyte sedimentation rate, and C-reactive protein as predictors of sepsis in patients with acute prostatitis.

BackgroundWe investigated the usefulness of inflammatory markers including the delta neutrophil index (DNI), erythrocyte sedimentation rate, C-reactive protein, and procalcitonin as early predictors of sepsis in patients with acute prostatitis (AP). In addition, we evaluated the efficacy of intermittent catheterization for the initial management of acute urinary retention (AUR) in patients with AP.Materials and methodsAll patients who presented to the emergency department and were admitted to the urology department from January 2011 to December 2013 were retrospectively reviewed. The clinical features, prostate-specific antigen levels, inflammatory marker levels, and urine and blood culture results were obtained from medical records. Patients who underwent urethrocystoscopy or prostate biopsy within 7 days were excluded.ResultsOf 132 patients (mean age, 64.8 years) in this cohort, 17 (12.9%) had sepsis and 22 (16.7%) had positive blood cultures. Escherichia coli was the most common isolate in blood and urine cultures. In multivariate analysis, the DNI and prostate-specific antigen were identified as predictors of sepsis. The DNI was a significant prognostic factor for bacteremia. In patients with AP, procalcitonin was not a significant predictor of sepsis. Of 19 patients with AUR, 10 needed Foley catheterization because of refractory AUR. C-reactive protein was a significant predictor of failure of the initial management of AUR.ConclusionsThe DNI is useful as a predictive factor for sepsis and bacteremia in patients with AP. Without mandatory cystostomy, intermittent catheterization could be one of the useful management options of AUR in patients with AP.

A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture

To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting. We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management. We identified 4794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6 ± 0.8 years. A total of 4084 (85%) men received urethral dilation, whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P <.001), treated in recent years (P = .002), and in hospitals in the West region (P = .003). In multivariate analysis, SPT placement was significantly associated with younger age (P = .004), public insurance (P = .03), recent treatment years (P = .02), and hospitals in the West region (P = .02). Income and hospital teaching status did not have significant association with initial treatment choice. Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend toward SPT placement. Patients who are younger, publicly insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.