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PurposeThis prospective case-control study explored the association between urinary magnesium levels and acute urinary retention (AUR) in individuals presenting to the emergency department.Materials and MethodsForty-six participants, comprising 23 cases and 23 age- and sex-matched controls, underwent urine analysis for magnesium, calcium, and creatinine concentrations. The exclusion criteria mitigated potential confounding factors.ResultsAUR cases exhibited significantly lower magnesium (5.97 vs.3.87, p = 0.031), calcium (11.04 vs. 5.3, p = 0.022), and creatinine (149.9 vs. 66.0, p = 0.005) levels (mg/dL) compared to controls. After adjusting for creatinine levels, no intergroup differences were observed. An inverse linear correlation was noted between the International Prostate Symptom Score and magnesium level (R2 = 0.15, p = 0.009). A magnesium cut-off of 3.57 mg/dL demonstrated 82.6 % sensitivity, 56.5 % specificity, and an AUC of 0.70. Patients with magnesium levels below 3.57 mg/dL had an 80 % higher risk of AUR (OR: 1.80, 95 % CI: 1.08–3.01, p = 0.016).ConclusionsThis study highlights urinary magnesium as a potential marker for risk of AUR, paving the way for larger prospective studies in this intriguing domain. Future interventions that manipulate magnesium levels may offer innovative avenues for managing lower urinary tract disorders.