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Acute urinary retention secondary to benign prostatic enlargement — MSRA MCQ

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ModerateBPHAcute urinary retention secondary to benign prostatic enlargementMSRA

A 68-year-old man with untreated bothersome voiding LUTS attributed to benign prostatic enlargement presents to an urgent treatment centre with acute painful urinary retention. He has been unable to void for 10 hours after taking an over-the-counter cold remedy containing pseudoephedrine for 3 days. He is afebrile, has a tender palpable bladder, and is catheterised immediately, draining 980 mL of clear urine. Urine dipstick is negative for leucocytes and nitrites; creatinine is 88 micromol/L and eGFR is 74 mL/min/1.73 m². He has no back pain, saddle sensory loss, leg weakness or constipation. Pseudoephedrine is stopped. He is reviewed the following morning. He is comfortable with the catheter in situ, has no postural symptoms, and has no history of cataract surgery. 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: C — Start an alpha blocker while the catheter remains in situ, then arrange a trial without catheter

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

This is acute urinary retention, most plausibly precipitated by pseudoephedrine in a man with underlying bladder outlet obstruction from benign prostatic enlargement. Immediate catheterisation has already been correctly performed and the precipitant has been withdrawn. NICE recommends offering an alpha blocker for acute urinary retention before catheter removal; therefore, an alpha blocker should be commenced with the catheter in situ before a planned trial without catheter. B is attractive because the reversible precipitant has been stopped, but it omits the recommended alpha-blocker step before catheter removal. C is inappropriate as 5-alpha reductase inhibitors reduce prostate volume and progression risk over months, not acutely; they do not substitute for alpha blockade when preparing for catheter removal. D unnecessarily prolongs catheterisation in an otherwise stable man without renal impairment, sepsis or neurological red flags. E may become appropriate after unsuccessful conservative and medical management, or with recurrent retention, but urgent surgery is not the routine next step after a first uncomplicated episode of acute retention.

Reference: NICE CG97: Lower urinary tract symptoms in men: management — Recommendations, section 1.7 Treating urinary retention (Published 2010; last reviewed 19 December 2024) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations