What criteria should I use to determine whether a patient with acute urinary retention requires referral to urology?

Criteria for referral to urology in patients with acute urinary retention include:

• Presence of urinary retention itself, especially if acute, warrants immediate catheterisation and consideration for specialist assessment ¹.
• Referral is indicated if retention is complicated by recurrent or persistent urinary tract infection, renal impairment suspected to be caused by lower urinary tract dysfunction, or suspected urological cancer ¹.
• Men with acute urinary retention should be offered an alpha blocker before catheter removal, but if retention persists or recurs, referral to urology is appropriate ¹.
• In women, referral should be considered if there are symptoms suggestive of voiding difficulty or palpable bladder after voiding, which may indicate retention or incomplete emptying ².
• Patients with neurological disease and urinary retention require specialist assessment if symptoms change or are severe, to guide management ³.

Summary: Acute urinary retention requires immediate catheterisation. Referral to urology is indicated if retention is complicated by infection, renal impairment, suspected cancer, persistent or recurrent retention, or if there are voiding difficulties or neurological causes affecting bladder function ¹,²,³.