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Acute urinary retention — MCCQE Part 1 MCQ

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HardAbdominal PainAcute urinary retentionMCCQE Part 1

A 72-year-old with benign prostatic enlargement has painful acute urinary retention and a palpable bladder. Catheterization drains 1.8 L; creatinine is elevated and bilateral hydronephrosis is present. What is the best subsequent plan?

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Correct answer: B — Maintain drainage and monitor renal function, electrolytes and urine output

Remove the catheter after decompression and monitor for recurrent pain: Prompt complete drainage is standard; routine immediate removal permits recurrent obstruction. Clamp the catheter after each 200 mL and measure creatinine tomorrow: Intermittent clamping has not shown benefit and can prolong pain and obstruction. Maintain drainage and monitor renal function, electrolytes and urine output: Ongoing catheterization treats the obstruction while serial output and biochemistry identify complications and guide definitive urologic management. Discharge after pain resolution with outpatient repeat renal biochemistry: Pain relief does not establish renal recovery or exclude substantial diuresis after obstruction is relieved. Begin dialysis now and reassess urinary obstruction after metabolic stabilization: Dialysis is reserved for persistent standard indications, not triggered by obstructive creatinine elevation before reassessment.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/urinary-retention/