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Antimuscarinic-induced urinary retention — SCE Geriatric Medicine MCQ

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HardContinenceAntimuscarinic-induced urinary retentionSCE Geriatric Medicine

An 88-year-old man is admitted with acute urinary retention and delirium. He has constipation, benign prostatic enlargement and takes solifenacin, amitriptyline, codeine and tamsulosin. Bladder scan shows 980 mL, creatinine has risen from 105 to 164 micromol/L and ultrasound shows mild bilateral hydronephrosis. Which medication should be reviewed/stopped?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Solifenacin

Solifenacin is an antimuscarinic that can precipitate urinary retention, constipation and delirium, especially with other anticholinergic drugs. The acute retention with hydronephrosis and AKI requires catheterisation and review of anticholinergic burden. Tamsulosin is likely beneficial for bladder outflow symptoms. The pearl is that antimuscarinics for bladder symptoms can worsen bladder emptying in men with prostatic obstruction.

Reference: BNF; STOPP/START v3; NICE NG56