skip to main content

Acute urinary retention due to presumed bladder outlet obstruction — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateUrologyAcute urinary retention due to presumed bladder outlet obstructionMSRA

A 72-year-old man presents to an urgent GP service with 10 hours of complete inability to pass urine and increasing suprapubic pain. For 18 months he has had nocturia, hesitancy and a poor urinary stream but has not sought treatment. He is afebrile and haemodynamically stable. He has no back pain, leg weakness, saddle sensory symptoms or constipation. Examination shows a tender, palpable bladder. Digital rectal examination shows a smooth enlarged prostate. Urine dipstick is negative for nitrites and leucocytes, and creatinine is 86 micromol/L (baseline 82 micromol/L). What is the most appropriate immediate management plan?

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

Reveal the answer and explanation

Correct answer: B — Immediately catheterise the bladder and offer an alpha blocker before catheter removal

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · C = shown as D · A = shown as E

This is acute urinary retention, most likely due to bladder outlet obstruction from benign prostatic enlargement: he has complete painful inability to void, a palpable bladder and preceding progressive voiding LUTS. There are no features suggesting infection or cauda equina syndrome. NICE recommends immediate catheterisation for acute retention. An alpha blocker should then be offered before catheter removal to improve the likelihood of successful voiding following a trial without catheter. A is insufficient because drug treatment does not promptly decompress the distended bladder. B may be relevant in chronic retention, particularly where there is renal impairment or a large residual volume, but imaging must not delay immediate drainage in acute retention. C is inappropriate because 5-alpha reductase inhibitors have a delayed effect and do not treat the immediate obstruction; they may subsequently be considered for longer-term management in an appropriately selected patient. D is not indicated because there is no clinical or dipstick evidence of UTI. E correctly combines urgent decompression with the recommended pharmacological measure before catheter removal.

Reference: NICE CG97: Lower urinary tract symptoms in men: management — Recommendations (2010; current online recommendations checked 15 August 2026) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations