EMed

Urinary retention in Men

Prompt evaluation appropriate to patient's discomfort

Indications for Catheterisation

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

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 Urology with a covering referral letter.

Catheterisation

  • May be via the urethral (size Ch 14) or supra-pubic route
  • Only make one attempt at urethral catheterisation before calling for urology
  • 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. If ↑ creat - refer to urology on call
  • 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).If concerned refer to urology Consultant
  • As alpha-blockers increase the chance of successful TWOC [BestBets], provide all patients with a prescription for Tamsulosin 0.4mg daily po, unless contraindicated
  • Referrals are triaged by a urology consultant who will decide on trial of void

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. Pre-discharge nursing / patient checklist
  • Reversible conditions i.e. alcohol, UTI, constipation, might be suitable for TWOC when corrected

Content by Alice Madden, Dr Íomhar O' Sullivan. Last review Mr. Cianan Brady, Dr IOS 20/08/23. Reviewed Mary Downey, A/CNM2, Urology/Urodynamics and Mr Frank O'Brien August 2019.