NICE have suggested guidance regarding the management of chronic urinary retention in an adult male (1):
- consider offering self- or carer-administered intermittent urethral catheterisation before offering indwelling catheterisation for men with chronic urinary retention
- carry out a serum creatinine test and imaging of the upper urinary tract in men with chronic urinary retention (residual volume greater than 1 litre or presence of a palpable/percussable bladder)
- catheterise men who have impaired renal function or hydronephrosis secondary to chronic urinary retention
- consider offering intermittent or indwelling catheterisation before offering surgery in men with chronic urinary retention
- consider offering surgery on the bladder outlet without prior catheterisation to men who have chronic urinary retention and other bothersome lower urinary tract symptoms (LUTS) but no impairment of renal function or upper renal tract abnormality
- consider offering intermittent self- or carer-administered catheterisation instead of surgery in men with chronic retention who you suspect have markedly impaired bladder function
- continue or start long-term catheterisation in men with chronic retention for whom surgery is unsuitable
- provide active surveillance (post void residual volume measurement, upper tract imaging and serum creatinine testing) to men with non-bothersome LUTS secondary to chronic retention who have not had their bladder drained.
If the patient presents with uncomplicated chronic urinary retention:
- catheterisation is indicated in:
- acute on chronic retention
- a patient who is ill, managing a medical emergency. Note that this may correct an underlying hyperkalaemia, but it is important to monitor the because there is a subsequent diuresis
Medical management should probably be confined to patients with symptoms but no other pathology. Pharmacological options include:
- alpha blockers
- 5 alpha reductase inhibitors
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