Urinary retention in Men

Prompt evaluation appropriate to patient's discomfort

Indications for Catheterisation

For patients presenting to CUH with acute retention, who have been catheterised, please complete the referral form, photocopy the ED notes and post all to Dolores O' Donnell or Mary Downey - Urology/Urodynamics Dept. CUH, Ext 22193 or 086 8228181.

Painful inability to pass urine (acute urinary retention)
Chronic urinary retention associated with urinary sepsis
Chronic urinary retention with renal dysfunction i.e. serum creatinine > 200 mmol/l
Occasionally overflow incontinence due to chronic retention

Catheterisation

May be via the urethral (size Ch 14) or supra-pubic route.
Only make one attempt at urethral catheterisation before calling for help.
The volume passed within 15 minutes of catheterisation must be recorded.
Send a C.S.U. (with copy to Urology).
Check that the foreskin is not left retracted.
Patients undergoing urethral catheterisation are not routinely given prophylactic antibiotics. However, if the dipstick urine is suggestive of infections, consider 80mg Gentamicin IV / IM prior to instrumentation of the urinary tract.

Assessment

Take a good history of previous urinary problems.
Check U. & E. plus creatinine.
Record drug history and if episode of retention was related to medication, alcohol consumption or constipation.
Digital Rectal Examination (DRE).
If suspicious of UTI commence Trimethoprim, 200 mgs. bd.
Contact urology doctor on call.
Do not do a P.S.A. (retention increases P.S.A. levels).
As alpha-blockers increase the chance of successful TWOC [BestBets], provide all patients with a prescription for Doralese 20mg b.d. PO, unless contraindicated

Further Management by Urology Team

If bladder volume is less than 1,500 mls. and if there is no significant history of prior lower urinary tract symptoms arrange for the Urology Nurse Specialist, to undertake a trial without catheter (T.W.O.C.).

Please supply

Patient's details, including phone number.
Copy of Emergency Department referral.
Copy of results to Urology Nurse Specialist folder in the ED.
If bladder Volumes > of 1500 mls. or if serum creatinine is greater than 200 mmol/l
- Admission may be considered for observation and fluid management prior to definitive therapy.
Patient with normal creatinine, arrange review as New Patient in urology OPD
Reversible conditions i.e. alcohol, UTI, constipation, might be suitable for TWOC when corrected.

Links

CUH TOV referral form
Email Dolores O' Donnell or Mary Downey
Urodynamics Dept. CUH, Ext 22193 or 086 8228181.

Content by Alice Madden, Dr Íomhar O' Sullivan 05/07/2004. Reviewed by Dr ÍOS 11/05/2005/ 26/05/2006, 26/05/2007. Next review 26/05/2008. Last review Mr. Cianan Brady, Dr IOS 23/01/17. Reviewed Mary Downey, A/CNM2, Urology/Urodynamics 03/01/2017.