Patient selection: acute urinary retention, treated by drainage with immediate catheterization
A trial of therapy without a catheter can be tried if the following criteria are present:
(1) no previous history of lower urinary tract symptoms or else only a short history of symptoms
(2) constipation
(3) therapy with a drug known to cause acute retention (antimuscarinic agent, sympathomimetic agent, calcium channel blocking agent, diuretic)
(4) no exclusion criteria (see below)
Exclusion criteria:
(1) evidence of renal impairment
(2) active urinary tract infection
(3) large volume (> 900 mL) of residual urine
(4) severe hematuria (clots may cause obstruction)
A man selected for a trial without a catheter must have any drug associated with acute retention discontinued. Some patients given the trial may not need surgery to relief the obstruction, but many will.
A man who is not a candidate for the trial should undergo surgery as soon as possible (following control of urinary tract infection or other problems).
