Dx: Urinary retention. A patient with a high normal or elevated PVR (>100-200 cc) and no obvious pelvic organ prolapse needs a work-up for urinary retention. There is a broad differential that can be divided into neurologic, obstructive, and pharmacologic etiologies.21 A referral is indicated so that a urologist can oversee the work-up.
Particularly worrisome causes of urinary retention are multiple sclerosis, which is more likely in a relatively young, otherwise healthy woman, and a pelvic mass. Medications are also a likely cause. The list of drugs that can induce urinary retention is extensive, and includes anticholinergics, antidepressants (tricyclics and some heterocyclics), antihistamines, and muscle relaxants, among others. If you’re unable to find a likely cause, a referral is indicated so that a urologist can oversee the work-up.
CORRESPONDENCE Abigail Lowther, MD, University of Michigan Department of Family Medicine, 24 Frank Lloyd Wright Drive, Lobby H, Ann Arbor, MI 48106-5795; abigaill@med.umich.edu
