What’s Your Diagnosis? Management of Acute Urinary Retention in the ED
February 22, 2021
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Community-Acquired Pneumonia in the Emergency Department right.
Case Presentation: Management of Acute Urinary Retention in the Emergency Department
A well-appearing 70-year-old man presents with abdominal pain and an inability to urinate…
- The patient says he is unable to urinate, so you suspect he has benign prostatic hyperplasia.
- The patient also complains of cough and runny nose. He appears well otherwise, and you wonder if it is related to his cold.
Your history revealed subacute lower urinary tract symptoms of frequency, urgency, and incomplete voiding. He had never taken alpha-blocking medications, and has never had AUR before. You performed a POCUS, which showed 800 mL of urine and mild bilateral hydronephrosis. Regarding his cold symptoms, he reported developing sinus congestion 2 days ago and starting pseudoephedrine. Your rectal exam showed prostatomegaly without tenderness. You suspected he had AUR from a combination of BPH and an alpha-adrenergic medication effect.
The first attempt to place a urethral catheter was unsuccessful. You recalled that men with BPH have an acute angulation at their prostatic urethra, so you switched to an 18F coudé catheter, and with lidocaine lubrication, you were able to successfully place the catheter. You relieved the obstruction and he felt much better. BMP showed no electrolyte abnormality or acute kidney injury, and he did not develop postobstructive diuresis while observed for 2 hours. You counseled him to stop the pseudoephedrine, started him on alfuzosin 10 mg orally daily, and arranged urology follow-up in 3 days.
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