Common Causes
-Obstructive causes e.g. BPH
-Medications e.g. Pain medications
-Spinal pathology
Treatment options
Acute urinary retention:
-Indwelling bladder catheter (Foley),
-Intermittent catheterization if the patient can do it.
-Catheter removal and trial of spontaneous voiding should be attempted every 48-72 hours. Catheter-associated UTI risk is about 5% per day.
-Start tamsulosin (alpha-blocker) will increase the success rate of spontaneous voiding trial.
–Finasteride is not helpful in this setting.
Abdominal CT: “Distended urinary bladder which may reflect urinary retention.”
Will order a bladder scan. Direct the nurse to straight cath the patient if the residual is greater than 250. Patient to initially void before the scan.
In a sample case for a patient with abdominal pain:
The patient initially voided 200 mL, the bladder scan showed 634 mL and with straight catheterization, the patient had 650 mL of output. The patient did comment to the nurse that he had significant relief of his symptoms.
Upon my return to reevaluate the patient, his abdomen is much softer. He still has some pain on deep palpation; however, this is inconsistent.
Based on the improvement in his symptoms after decompression of the bladder, then recommend that further investigation be performed to evaluate the urinary retention that has been present since at least April.