Obstructive uropathy from bladder outlet obstruction — ESENeph MCQ

Correct answer: D — Catheterise the bladder and monitor after decompression

The best answer is “Catheterise the bladder and monitor after decompression”. NICE advises catheterisation when chronic retention has caused impaired renal function or hydronephrosis. After drainage, large urine losses can emerge, so volume status, urine output, creatinine, sodium and potassium are monitored. “Arrange outpatient observation without bladder drainage” is less appropriate because impaired renal function and hydronephrosis are explicit indications for catheterisation “Start an ACE inhibitor before relieving the obstruction” is less appropriate because this does not address the post-renal cause and may worsen filtration during acute obstruction “Perform kidney biopsy before urinary drainage” is less appropriate because the structural cause is already evident and should be relieved promptly “Restrict fluid immediately after decompression” is less appropriate because post-obstructive diuresis can cause volume and electrolyte losses that require measured replacement

Reference: NICE CG97: lower urinary tract symptoms in men: https://www.nice.org.uk/guidance/cg97/chapter/recommendations