skip to main content

Chronic urinary retention causing renal impairment, likely secondary to bladder outlet obstruction — MSRA MCQ

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

HardUrologyChronic urinary retention causing renal impairment, likely secondary to bladder outlet obstructionMSRA

A 74-year-old man reports 18 months of progressive hesitancy, weak stream, intermittency and overflow dribbling. He now voids small volumes every 1 to 2 hours and wakes wet most mornings, but has no suprapubic pain. He has no dysuria, fever, visible haematuria, weight loss, back pain or neurological symptoms. Digital rectal examination shows a smooth enlarged prostate. Urine dipstick is negative for blood, nitrites and leucocytes. Bladder scan immediately after voiding shows a residual volume of 1.25 L. Creatinine is 156 micromol/L; his documented value 8 months ago was 88 micromol/L. 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 — Catheterise the bladder now and arrange urgent specialist assessment with upper urinary tract imaging

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

This is chronic urinary retention with clinically important renal impairment, most likely from bladder outlet obstruction due to benign prostatic enlargement. The decisive features are the very large post-void residual volume (1.25 L), a palpable-equivalent chronically overdistended bladder state with overflow symptoms, and a substantial creatinine rise from baseline. NICE recommends serum creatinine testing and upper urinary tract imaging in chronic retention when residual volume exceeds 1 L or the bladder is palpable/percussable. It also recommends catheterisation when renal impairment or hydronephrosis is secondary to chronic retention. Specialist assessment is indicated because LUTS are complicated by suspected renal impairment. A and B may be appropriate pharmacological approaches for uncomplicated bothersome LUTS, but neither provides the necessary immediate bladder drainage or addresses potential upper tract damage. D inappropriately delays decompression and investigation in a patient with renal dysfunction. E may be considered before long-term indwelling catheterisation in selected chronic retention, but immediate drainage is required here; the patient also needs urgent assessment of renal tract consequences rather than a delayed primary-care review.

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