ICS definition – “patient unable to pass any urine despite having a full bladder, which on examination is painfully distended and readily palpable or percussible”
Classically differentiated from chronic retention by the presence of pain.
Can be classified as ‘spontaneous’ or ‘precipitated’.
Classification by underlying cause:
Often multifactorial – i.e., not one underlying cause from above.
Beware pseudoretention – false bladder scans (haematoma, ascites, pelvic collections).
Assessment
“Concurrent assessment with therapeutic catheterisation”
History
- Duration of symptoms / preceding LUTS or other symptoms, presence of pain
- Inciting events – procedures / medications / alcohol / drugs
- Red flags – haematuria, back pain, neurological symptoms, nocturnal or faecal incontinence
- Known urological history – prostatic, strictures, catheterisation, retention episodes
- Medical history, medications, surgical history
- Social history – smoking, alcohol, family and family history, occupation
Examination
- Level of distress
- Fevers, haemodynamics
- BMI and habitus, performance status or frailty
- Abdominal exam – palpable or percussible bladder, scars
- Genital exam and DRE – prostate, phimosis, prostatitis
- Neurological exam
Investigations
- Urine culture and microscopy (catheter sample)
- Bloods – renal function testing, electrolytes, FBC (and compare to previous)
- PSA generally not appropriate in acute setting
- Upper tract imaging – ultrasound or CT to assess kidneys
Management
Placement of catheter – usually urethral IDC. Documentation of amount drained. Alternatives SPC or ISC
TOV in 3 – 7 days
- Start alpha blocker at time of IDC placement – 1.5 – 2 x improvement in successful TOV – Cochrane review – most studies alfuzosin
- Wait until any concurrent UTI is treated
Exclude high pressure retention – renal function testing and imaging.
Watch for post-obstructive diuresis – 4 hours observation of hourly measured outputs.
Identify and treat any underlying cause.
Second TOV after failure successful 30 % of the time.
Up to 80 % of patients who pass TOV after AUR will come to need surgery (therefore 5ARIs should be strongly considered to reduce this risk)
Risk factors for failing TOV:
- Age
- Severe LUTS
- Over 1 L drained