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Acute Urinary Retention & Prostatic Embolization

Interventional Radiology · Cochin Hospital AP-HP · Paris

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🟢 Urinary emergency · Prostate adenoma

Acute Urinary Retention: Embolization as an Alternative to Emergency Surgery

AUR due to BPH · Indwelling catheter · Day-case embolization · Catheter removal · Avoiding surgery · Paris Cochin AP-HP

Quick answer

Acute urinary retention due to benign prostatic hyperplasia (BPH) first requires an indwelling catheter. Prostatic artery embolization, performed as a day case, then allows catheter removal and often avoids prostate surgery.

What is acute urinary retention?

Acute urinary retention (AUR) is the sudden inability to urinate, causing painful distension of the bladder. In men, the most common cause is a prostate adenoma (BPH) whose volume increases suddenly, obstructing the urethra. It requires urgent bladder catheterisation.

The standard treatment consists of leaving an indwelling urinary catheter for several weeks, then performing a surgical resection (TURP). Prostatic artery embolization offers a minimally invasive alternative that in many cases allows catheter removal without emergency surgery.

Embolization in acute urinary retention

Prostatic artery embolization (PAE) can be performed with the catheter in place. By reducing prostate volume by 20 to 30% within a few weeks, it then allows an attempt at catheter removal (RAUSP: catheter removal after prostatic embolization). This strategy has been validated in several prospective studies.

✅ Advantages

  • Avoids emergency surgery
  • Performed with the catheter in place
  • Day case, local anaesthesia
  • Ejaculation preserved
  • RAUSP success rate: 60–70%

⚠️ Limitations

  • Success not guaranteed (30–40% keep the catheter)
  • 2–4 week delay before removal
  • Prior work-up required (PSA, MRI)
  • If it fails: surgery (TURP) remains possible

Frequently asked questions

Is acute urinary retention an emergency?
Yes, it is a medical emergency requiring rapid drainage (catheterisation or suprapubic catheter) to relieve the bladder, before considering a definitive treatment such as prostatic embolization.
Can prostatic embolization be performed right after the episode of retention?
A delay is generally needed after the acute episode, to stabilise the situation (catheterisation, work-up), before offering a scheduled embolization procedure.
Can the urinary catheter be removed after embolization?
Catheter removal is attempted gradually after the procedure, depending on the improvement in obstructive symptoms, in liaison with your urologist.

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Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.

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