From the Guidelines
The initial workup for a patient with urinary retention in the emergency department should begin with a focused history and physical examination, followed by bladder catheterization to relieve the retention, as recommended by the most recent guidelines 1. When evaluating a patient with urinary retention, it is essential to ask questions about their medical history, including any previous urinary tract infections, prostate issues, or neurological conditions.
- Questions to ask include:
- What are the patient's symptoms, and how long have they been experiencing them?
- Has the patient had any previous urinary tract infections or prostate issues?
- Is the patient taking any medications that could be contributing to the retention, such as anticholinergics, opioids, or alpha-agonists?
- Has the patient experienced any recent trauma or surgery that could be causing the retention? To evaluate the patient, the following tests and examinations should be ordered:
- Bladder catheterization to relieve the retention and measure the post-void residual volume
- Urinalysis and urine culture to assess for infection
- Basic metabolic panel to evaluate renal function
- PSA levels in older men to screen for prostate issues
- Focused neurological examination to identify potential neurogenic causes
- Bedside bladder ultrasound to confirm retention and estimate volume before catheterization Additional imaging, such as renal ultrasound or CT abdomen/pelvis, may be indicated if obstruction is suspected 1. Medication review is essential, and for men with benign prostatic hyperplasia, consider starting tamsulosin 0.4mg daily or similar alpha-blocker 1. For retention due to infection, appropriate antibiotics should be initiated. This systematic approach addresses the immediate need for bladder decompression while investigating underlying causes to guide further management and prevent recurrence.
From the Research
Initial Workup for Urinary Retention in the ED
The initial workup for a patient presenting with urinary retention in the emergency department (ED) involves a thorough evaluation to determine the underlying cause of the retention.
Questions to Ask
- What are the patient's symptoms, and how long have they been experiencing them? 2
- Is the patient experiencing any pain or discomfort? 2
- Has the patient had any previous episodes of urinary retention? 3
- What medications is the patient currently taking, as some medications can cause urinary retention? 4
- Does the patient have any underlying medical conditions, such as benign prostatic hyperplasia (BPH) or neurologic disorders? 3, 5
Diagnostic Tests to Order
- Urinalysis to check for infection or other abnormalities 5
- Post-void residual (PVR) measurement to assess bladder emptying 5
- Renal function tests to evaluate kidney function 5
- Imaging studies, such as ultrasound or CT scan, to evaluate the urinary tract for any obstruction or other abnormalities 5
Treatment
- Bladder decompression using urethral or suprapubic catheterization to relieve the obstruction and mitigate the underlying cause of retention 3, 2, 6
- Pain management to relieve discomfort and pain 2
- Discontinuation or reduction of any medications that may be contributing to the urinary retention 4
Special Considerations
- Elderly patients are at higher risk for developing drug-induced urinary retention, and careful consideration should be given to their medication regimen 4
- Patients with BPH may require alpha blockers to facilitate catheter removal and prevent future episodes of urinary retention 3
- Surgical treatment may be necessary in some cases, but it carries a higher rate of morbidity and mortality in men presenting with acute urinary retention compared to those presenting with symptoms alone 3