From the Guidelines
Yes, catheterization is recommended for this patient with 500ml of retained urine on bladder scan and suprapubic pain. This clinical picture suggests acute urinary retention, which requires prompt intervention, as indicated by the International Society for Infectious Diseases in their 2024 update 1. The patient's symptoms, including suprapubic pain and a post-void residual volume of 500ml, meet the criteria for management of acute urinary retention, as outlined in the position paper.
Key Considerations
- The patient's post-void residual volume exceeds 500 cm3, which is a clear indication for catheterization, especially in the presence of symptoms such as suprapubic pain 1.
- The presence of suprapubic pain suggests bladder distension, which can lead to complications if left untreated, including urinary tract infections or upper urinary tract damage.
- Prompt catheterization can relieve pressure, alleviate pain, and prevent these complications.
Recommendations
- Insert a urethral catheter (14-16 French for adults) using aseptic technique to minimize the risk of catheter-associated urinary tract infections, as emphasized in the position paper 1.
- Allow complete bladder drainage and document the residual volume to ensure that the catheterization is effective.
- Monitor the patient's pain relief, vital signs, and urine output after catheterization to assess the effectiveness of the intervention and identify any potential complications.
- The catheter should remain in place until the underlying cause of the acute urinary retention is identified and addressed, as indicated by the patient's clinical response and the results of any diagnostic tests.
From the Research
Urinary Catheterization for Post-Void Residual Volume of 500ml and Suprapubic Pain
- A patient with a post-void residual volume of 500ml and suprapubic pain may require urinary catheterization to relieve the obstruction and prevent further complications 2, 3.
- The decision to undergo catheterization should be based on a thorough history, physical examination, and selected diagnostic testing to determine the cause of urinary retention 2.
- Suprapubic catheterization may be a preferred option for short-term management, as it has been shown to reduce the risk of urinary tract infections and urethral strictures compared to urethral catheterization 4, 5.
- However, suprapubic catheterization is contraindicated in patients with bleeding disorders and those with a history of bladder cancer 5.
- Urethral catheterization is a commonly performed procedure, but it carries the risk of complications such as infection, injury to the urethra or bladder, and catheter malfunction 6.
- Prompt replacement of the urethral catheter with an alternative method of bladder drainage, such as spontaneous voiding or clean intermittent catheterization, is essential to prevent complications 6.
- The choice of catheterization method should be individualized based on the patient's specific needs and medical history, and should be done under the supervision of a physician 2, 3.