Patient case: Urinary Retention
A 55-year-old man presents to the emergency department with complaints of an inability to urinate for the past 12 hours. He reports feeling an intense urge to urinate, but is unable to pass any urine. He also mentions discomfort in his lower abdomen and a feeling of fullness. The patient denies any pain, fever, or blood in the urine. His medical history is significant for benign prostatic hyperplasia (BPH), which he has been managing with alpha-blockers for the past 2 years.
On physical examination, the patient appears uncomfortable, with a distended lower abdomen. A bladder scan confirms that his bladder is significantly full. Digital rectal examination reveals an enlarged, firm, and non-tender prostate, consistent with the patient’s history of BPH. There are no signs of acute infection or other significant abnormalities on examination.
The diagnosis of acute urinary retention secondary to BPH is made. The patient is catheterized, and approximately 800 mL of urine is drained. After catheterization, the patient feels immediate relief. The physician discusses treatment options, including further management of his BPH with medications, and possible surgical intervention if necessary. A referral to a urologist is made for follow-up care.
A) Painful urination
B) Inability to urinate and lower abdominal discomfort
C) Blood in the urine
D) Fever and chills
A) Urinary tract infection
B) Bladder stones
C) Benign prostatic hyperplasia (BPH)
D) Prostate cancer
A) Oral antibiotics
B) Catheterization to drain the bladder
C) Surgical removal of the prostate
D) Administration of pain medications
A) No further treatment necessary
B) Referral to a urologist for continued management of BPH
C) Starting dialysis
D) Immediate prostate surgery
