2 Indications and current treatments
2.1 Non‑obstructive urinary retention is the inability to empty the bladder with no physical obstruction to the urine flow. It can occur as a result of neurological disorders, such as multiple sclerosis or spinal cord disease, or it can be idiopathic. In younger women, it may be caused by Fowler's syndrome, which is a rare disorder in which the urethral sphincter fails to relax to allow urine to be passed normally. This guidance covers idiopathic chronic non‑obstructive urinary retention only (including Fowler's syndrome). Chronic non‑obstructive urinary retention can cause complications such as recurrent urinary tract infections and chronic kidney disease.
2.2 Initial management in men is usually with drug therapy, such as alpha blockers, and urethral dilatation; whereas in women it is usually urethral dilatation only. The efficacy of these options is limited and most patients need to do clean intermittent self‑catheterisation or have an indwelling catheter. If these measures are unacceptable to the patient or do not work well enough, then surgical urinary diversion procedures may be considered. Sacral nerve stimulation has been introduced as another option for patients with chronic non‑obstructive urinary retention.