skip to main content

Chronic urinary retention secondary to benign prostatic enlargement with hydronephrosis and renal impairment —

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

ModerateBPHChronic urinary retention secondary to benign prostatic enlargement with hydronephrosis and renal impairmentMSRA

A 75-year-old man presents with gradually worsening hesitancy, weak stream, straining and overflow nocturnal enuresis over 9 months. He has not had acute painful retention. Digital rectal examination shows a smooth enlarged prostate, and there is a palpable, non-tender suprapubic bladder. Urine culture is negative. Bladder scan after voiding shows a residual volume of 1.35 L. His creatinine is 142 micromol/L (previously 84 micromol/L), and renal ultrasound shows bilateral hydronephrosis. He is haemodynamically stable and has no features of sepsis or neurological compression. What is the most appropriate next management plan?

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

Reveal the answer and explanation

Correct answer: E — Arrange bladder drainage by catheterisation and specialist urological assessment

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

This man has chronic urinary retention complicated by upper-tract obstruction and renal impairment: the discriminating features are a residual volume above 1 L, palpable bladder, bilateral hydronephrosis and a substantial rise in creatinine from baseline. NICE recommends catheterisation when chronic urinary retention causes impaired renal function or hydronephrosis, and referral for specialist assessment where LUTS are complicated by retention or renal impairment attributable to lower urinary tract dysfunction. A and E may be appropriate pharmacological approaches for uncomplicated bothersome LUTS due to benign prostatic enlargement, but neither provides the required immediate bladder drainage in obstructive chronic retention with renal consequences. B is inappropriate because surgery without prior catheterisation is only an option in chronic retention when there is no renal impairment or upper-tract abnormality. D is unsuitable because surveillance without drainage is reserved for non-bothersome chronic retention in men who have not had their bladder drained; this patient has symptomatic obstruction with hydronephrosis and renal impairment. Catheter drainage should be followed by urological assessment to determine the cause, assess renal recovery and plan definitive management.

Reference: NICE CG97: Lower urinary tract symptoms in men: management, recommendations 1.1.14 and 1.7.4-1.7.7 (Published 2010; last updated 3 June 2015) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations