Mr Garcia - unable to pass urine

Question 1

Older patient unable to urinate but desire to do so: has enlarged smooth symmetrical prostate. His suprapubic area is tender. What’s the diagnosis?

Answer 1

Acute urinary obstruction - probably due to benign prostatic hyperplasia

Question 2

Management of this patient?

Answer 2

1. Catherisation and IV fluids
2. Assess renal function by monitoring blood urea, creatinine, electrolytes, and monitoring urine output over following 12-48 hours with the catheter. Raised creatinine = suspect a diuresis.
3. Assess cause of obstruction - in this example its likely BPH as patient is not constipated. Should still take PSA to exclude cancer
4. Trial without catheter, if patient voids <1L and has normal renal function. After giving meds, just wait for patient to urinate after catheter removal

Question 3

What does a volume voided of >1L, after catheter insertion, suggest about the nature of the urine retention?

Answer 3

acute on chronic, as its rare with an acute episode to get such a large volume

Question 4

What medications are given when conducting trail without catheter on patient? (2)

Answer 4

1. patient is started on an alpha blocker, to relax the urinary sphincter
2. patient given a single dose of ABs to prevent UTI after catheter removal

Question 5

What is given to patient with successful trial without catheter (2)

Answer 5

discharged with

1. a blocker
2. 5a reductase inhibitor (warned recurrence is very high)

Question 6

What is given to patient with unsuccessful trial without catheter (2)

Answer 6

1. discharged with indwelling/intermittent catheter

2. booked for surgical resection to their problem (TURP likely)