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Postoperative urinary retention — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Postoperative urinary retentionUSMLE Step 3

A 72-year-old man cannot void after hip arthroplasty. Bladder scan shows 780 mL; catheterization relieves symptoms. He fails a trial without catheter the next day and has no neurologic deficit or urethral injury. What is the best next step?

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Correct answer: D — Recatheterize, start an alpha blocker, and repeat the voiding trial

The best answer is “Recatheterize, start an alpha blocker, and repeat the voiding trial”. Recurrent postoperative retention requires decompression. An alpha blocker improves the chance of a later successful trial; immediate prostate surgery is not indicated for transient postoperative retention. Bladder decompression and an alpha blocker precede a later trial without catheter.

Reference: NCBI Bookshelf: Postoperative Urinary Retention: https://www.ncbi.nlm.nih.gov/books/NBK549844/