HNY Policy and Pathway Repository - York

Idiopathic chronic urinary retention which is not obstructive 

This intervention is commissioned for treatment of idiopathic chronic non-obstructive urinary retention if ALL the following criteria have been met: 

• Recommendations 1.1, 1.2 and 1.3 of NICE IPG536 are fulfilled by the provider. 
• Other treatment options have been ineffective or not tolerated. 
• This intervention has been recommended as an outcome of an MDT review. 

This intervention is not commissioned for urinary retention resulting from neurological disorders. 

Non‑obstructive urinary retention is the inability to empty the bladder with no physical obstruction to the urine flow. It can occur because 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. 

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. 

Sacral nerve stimulation for idiopathic chronic non‑obstructive urinary retention involves applying an electric current to one of the sacral nerves by an electrode placed through the corresponding sacral foramen. It aims to restore the ability to empty the bladder voluntarily and to remove the need for catheterisation. 

IPG536 Sacral nerve stimulation for idiopathic chronic non-obstructive urinary retention | Guidance | NICE 

Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction | NEJM Evidence