Management

The first objective is to relieve the patient of the discomfort so provide some strong opiate analgesia. Try conservative methods first - privacy, sound of running water, and making the patient stand up.

Catheterise if these conservative methods do not provide relief. First, try a Foley catheter inserted via the urethra; if unsuccessful, try a suprapubic catheter.

Some factors that should discourage an attempt at simple urethral catherisation include:

• previous prostatectomy
• known urethral stricture
• history of difficult catheterisation
• non-retractile foreskin

NICE have suggested guidance regarding the management of acute urinary retention in an adult male (1):

• immediately catheterise men with acute retention
• offer an alpha blocker to men for managing acute urinary retention before removal of the catheter

Reference:

• 1) NICE (May 2010). Lower urinary tract symptoms The management of lower urinary tract symptoms in men