Key facts

  • Acute retention is a sudden inability to urinate; chronic retention is a gradual inability to completely empty the bladder2.
  • See a health care professional right away if you are unable to urinate or have severe pain in your abdomen. Acute urinary retention can be life threatening1.
  • A catheter can stay in place (indwelling) or be placed and removed as needed (intermittent); medicines and several procedures are also used3.
  • In published studies of prostate artery embolization (PAE) for retention, many men but not all came off the catheter, and some needed one again later9,10.
  • Talk with your doctor before you decide. This information does not replace personal medical advice.

Acute vs. chronic retention

Acute urinary retention is a sudden inability to urinate. Chronic retention is a gradual inability to completely empty the bladder2. An enlarged prostate is one cause of retention, and there are others, including some medicines and nerve-related conditions1. The risk of a sudden inability to urinate rises with age and is linked with urinary symptoms, a slower flow, and a larger prostate7.

Questions to ask

  • Is my retention acute or chronic, and how does that change what we do next?
  • Besides an enlarged prostate, what else could be contributing to this?
  • Could any of my medicines be part of the cause?

Why this matters: Retention isn't always just BPH. Naming the likely cause changes which tests and options make sense to discuss next.

Getting care right away

See a health care professional right away if you are unable to urinate or have severe pain in your abdomen. Acute urinary retention can be life threatening1.

Catheters: indwelling vs. intermittent

A catheter drains the bladder. It can stay in place (indwelling), or it can be put in and taken out as needed (intermittent)3.

Questions to ask

  • Which type of catheter fits my situation, and for how long might I need one?
  • What would a trial without a catheter involve, and what counts as success?

Why this matters: Knowing the catheter type and the plan around it helps you ask better follow-up questions at each visit.

Medicines and the trial without a catheter

Medicines used for retention linked to an enlarged prostate include alpha-blockers and 5-alpha reductase inhibitors3. In randomized trials, more men could urinate after the catheter came out when they took an alpha-blocker first: about 6 in 10, versus about 4 in 10 on placebo6.

Questions to ask

  • Would a medicine before my trial without a catheter make sense for me?
  • How will we know if the trial without a catheter worked?

Why this matters: A medicine beforehand may change the odds of a successful trial without a catheter, so it's worth asking about before the catheter comes out.

Tests your doctor may use

Tests a doctor may use include urinalysis, PSA or biopsy, urodynamic tests, cystoscopy, and transrectal ultrasound4. A sudden inability to urinate is one of the listed complications of an enlarged prostate5.

Questions to ask

  • Which of these tests make sense for me, and what will each one tell us?
  • Would a urodynamic test change what we decide to do?

Why this matters: The right tests can help confirm the cause of retention before moving to medicines or a procedure.

Does PAE help with urinary retention?

Whether prostate artery embolization (PAE) is worth discussing for retention depends partly on whether your bladder muscle still works, which is covered below. Ask whether your urologist and an interventional radiologist would plan your care together. In published studies of PAE for retention, many men but not all came off the catheter, and some needed one again later9,10.

A 2026 interventional radiology practice guidance for prostate artery embolization says PAE can be considered for men with moderate to severe urinary symptoms who want to preserve erectile or ejaculatory function or avoid urinary incontinence, and reports retrograde ejaculation after PAE in less than 2% of men8. The same guidance describes PAE as an option for men who are not considered candidates for surgery because of older age, several other medical conditions, a bleeding disorder, or being unable to stop blood-thinning medicines, and also for men who refuse surgery or who prefer a procedure without prior medical therapy8. The guidance describes PAE as durable for most men but reports that about 20–25% need a second procedure by 5 years, rising over time; in one cohort of 1,072 men, reintervention was 21.1% at 5 years and 58.1% at 10 years8. Ask how this compares with the other options you are considering.

Procedures used for retention linked to an enlarged prostate include surgery to remove part of the prostate, laser therapy, electrovaporization, water vapor therapy, and the prostatic urethral lift3. Ask which of these, or PAE, fits your situation and why.

Questions to ask

  • Has my bladder function been checked, and how?
  • What would "catheter independence" realistically mean in my case: likely, possible, or unlikely?
  • Who would be involved in my care if I considered PAE: my urologist, an interventional radiologist, or both?
  • Which procedures or surgery would you consider for me, and how do they compare?

Why this matters: PAE is not a guarantee of coming off a catheter for everyone. Asking about your own bladder function helps set realistic expectations before you decide.

Checking bladder function first

For long-standing retention, guidance from interventional radiologists says bladder function should be checked first, sometimes with urodynamic testing, because a bladder that can't squeeze may not improve with any prostate procedure8.

Questions to ask

  • Has my bladder's squeezing strength (contractility) been checked?
  • Would urodynamic testing help answer that before we talk about any procedure?

Why this matters: If the bladder muscle itself isn't working well, the problem may not improve with any prostate procedure.

Common questions

Is urinary retention an emergency?

It can be. See a health care professional right away if you are unable to urinate or have severe pain in your abdomen. Acute urinary retention can be life threatening1. Talk with your doctor before you decide.

What's the difference between acute and chronic urinary retention?

Acute retention is a sudden inability to urinate. Chronic retention is a gradual inability to completely empty the bladder2. An enlarged prostate is one cause of urinary retention, and there are others, including some medicines1. Talk with your doctor before you decide.

Can PAE help with urinary retention?

It may be discussed after your bladder function has been checked. In published studies, many men but not all came off the catheter, and some needed one again later9,10. Talk with your doctor before you decide.

Will I ever get off my catheter?

It depends on the cause of your retention and whether your bladder muscle still works well. In published studies of PAE for retention, many men but not all came off the catheter, and some needed a catheter again later9,10. No option can promise catheter independence. Talk with your doctor before you decide.

Why would my doctor check my bladder function before a procedure?

For long-standing retention, 2026 interventional radiology practice guidance says bladder function should be checked first, sometimes with urodynamic testing, because a bladder that can't squeeze may not improve with any prostate procedure8. Talk with your doctor before you decide.

Talk with your doctor before you decide. This information does not replace personal medical advice. Read the medical disclaimer.

Sources

  1. NIDDK, Symptoms and Causes of Urinary Retention (reviewed 2019) ↩︎
  2. NIDDK, Urinary Retention (reviewed 2019) ↩︎
  3. NIDDK, Treatment of Urinary Retention (reviewed 2019) ↩︎
  4. NIDDK, Prostate Enlargement (Benign Prostatic Hyperplasia) ↩︎
  5. MedlinePlus, Enlarged prostate ↩︎
  6. Fisher et al., Cochrane review of alpha-blockers before catheter removal, 2014 (PMID 24913721) ↩︎
  7. Jacobsen et al., risk factors for acute urinary retention, J Urol 1997 (PMID 9224329) ↩︎
  8. Society of Interventional Radiology (SIR), 2026 Practice Guidance Document for Prostatic Artery Embolization (PMID 42223385) ↩︎
  9. Marchi et al., PAE for acute urinary retention, 2023 (PMID 36801097) ↩︎
  10. Carnevale et al., PAE for acute urinary retention, 2013 (PMID 23434084) ↩︎