Acute urinary retention is uncommon in children and can be due to several causes. Bladder catheterization seems to play an important role in the initial management
We aimed to assess common causes and initial management of acute urinary retention at a tertiary center, focusing particularly on the role of bladder catheterization in the early emergency setting.

We retrospectively analyzed all consecutive children admitted to the emergency department with acute urinary retention from 2010 to 2020. We evaluate the results considering the subgroup analyses of patients with more, and less than 5 years old. All children included in the study achieved urinary continence and be toilet trained. Exclusion criteria were: post-operative acute urinary retention, neonatal age, mental disability and known urological or neurological disorders. All patients received medical treatment initially including enemas and local anti-inflammatory depending on the identified cause of acute urinary retention.

193 patients were included. Median age was 3 (2-16) years; 53.4% were girls. The majority (124/193; 64.2%) were managed without catheterization. These patients were significantly younger than the remainder (median ager 3- vs 4-year-old, p<0.01) and the most common diagnosis was external genitalia inflammation (53%). Of the remaining 69 patients, the most common diagnoses were external genitalia inflammation (35%), urinary tract infection (17%) and idiopathic acute urinary retention(13%). Of these 69 patients, 34 (49%) restored spontaneous micturition after a single catheterization, instead, the remining 35 (51%; 18% of all the 193 patients), required admission due to failure to re-establish micturition. In half of the latter (18/35), a previously unknown urological condition was diagnosed. Patients requiring admission were more commonly males (63%, p=0.01), with higher incidence of abnormal ultrasound (33% vs 7%, p<0.001).

Acute urinary retention is commonly due to external genitalia inflammation particularly in patients <5-year-old and these patients can generally be managed without catheterization. When no clear cause of retention based on history taken, physical examination, laboratory assessment or imaging was available, hospitalization should be a choice for additional evaluations. No clear indication for catheterization was available in this study. 
In our experience, 18% of patients required hospital admission, due to the need for prolonged catheterization and half of these were diagnosed with a urological condition previously unknown.

Bladder catheterization is a treatment option of pediatric patients with acute urinary retention, and can be placed when spontaneous micturition is not achieved after others less invasive strategies. Hospitalization should be avoided and performed only when suspect of urological conditions or when additional evaluations are necessary.

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Acute Urinary retention in children Ana-Marija Schmidt , Karin Hirsch, Michael Schroth, Maximilian Stehr, Frank-Mattias Schäfer                     J Pediatr Urol 2020 Dec;16(6):842.e1-842.
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Continence 2S2 (2022) 100441
DOI: 10.1016/j.cont.2022.100441