Rigi10™ Malleable Penile Prosthesis
Also Known As
Delayed urination, Difficulty initiating urination, Poor urinary stream, Hesitant urination, Voiding dysfunction, Impaired urinary flow, Urinary flow hesitancy
Definition
Urinary hesitancy is defined as difficulty initiating or maintaining a urine stream, characterized by a delay in the onset of voiding and/or a decreased force of urinary flow.1 This condition occurs when there is impaired coordination between the bladder muscles, pelvic floor, and nervous system, resulting in challenges with starting urination or sustaining a consistent flow.2 Urinary hesitancy can range from mild difficulty to complete urinary retention, where a person is unable to void their bladder completely.3 While most common in older males due to an enlarged prostate, urinary hesitancy can affect individuals of any age and gender, significantly impacting quality of life and potentially leading to complications if left untreated.4
Clinical Context
Urinary hesitancy presents in various clinical scenarios and affects both men and women, though with different underlying etiologies.1 In men, the most common cause is benign prostatic hyperplasia (BPH), which affects approximately 50% of males by age 60.2 The enlarged prostate puts pressure on the urethra, making it difficult to initiate or maintain urination. Other causes include neurological disorders (multiple sclerosis, stroke, diabetes mellitus), medications (anticholinergics, alpha-adrenergic agonists, antidepressants), urethral strictures, and urinary tract infections.3
In women, urinary hesitancy may develop during pregnancy and after childbirth, with risk factors including prolonged second stage of labor, episiotomy, perineal tearing, and use of forceps or vacuum during delivery.4 Pelvic floor dysfunction, urinary tract infections, and neurological conditions are also significant contributors to female urinary hesitancy.
Diagnostic evaluation typically begins with a thorough medical history and physical examination, followed by urinalysis and urine culture to rule out infection. Additional tests may include uroflowmetry, post-void residual measurement, cystoscopy, and urodynamic studies to assess bladder and urethral function.1 Treatment approaches vary based on the underlying cause and may include medications (alpha-blockers for BPH, antibiotics for infections), pelvic floor physical therapy, intermittent catheterization, or surgical interventions for anatomical obstructions.3
Untreated urinary hesitancy can progress to urinary retention, which is considered a medical emergency requiring immediate intervention to prevent bladder damage and potential kidney complications.4