Urinary retention in Men

Prompt evaluation appropriate to patient's discomfort

Indications for Catheterization

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 Alice Madden - urology specialist nurse, Blackwater Suite, OPD

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 catheterization before calling for help.
The volume passed within 15 minutes of catheterization must be recorded.
Send a C.S.U. (with copy to Urology).
Check that the foreskin is not left retracted

In Mercy University Hospital - all patients with acute retention are to receive 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. b.d.
Contact urology doctor on call.
Do not do a P.S.A. (retention increases P.S.A. levels).
Provide all patients with a prescription for alpha-blockers (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, (A Madden bleep 476) 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

Alice Madden CUH Bleep 476 or ext 22887. Alice Madden Referral Form