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Chronic urinary retention secondary to benign prostatic enlargement — MSRA MCQ

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HardBPHChronic urinary retention secondary to benign prostatic enlargementMSRA

A 76-year-old man is assessed in urology after a routine examination identified a painless palpable bladder. He reports a gradually weaker stream and occasional double voiding over several years but is not troubled by these symptoms (IPSS 3; quality-of-life score 1). He has had no acute retention, recurrent UTI, visible haematuria, nocturnal enuresis, flank pain or neurological symptoms. Digital rectal examination shows a smooth enlarged prostate. Uroflowmetry demonstrates a low maximum flow rate. Post-void residual volumes are 1.20 L and 1.15 L on two assessments 2 weeks apart. Urine culture is negative. Serum creatinine is 86 micromol/L (eGFR 74 mL/min/1.73 m²), unchanged from 2 years previously, and renal ultrasound shows no hydronephrosis. He has not undergone bladder drainage. The urologist considers this chronic retention secondary to benign prostatic enlargement. What is the most appropriate management plan?

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

Reveal the answer and explanation

Correct answer: B — Provide active surveillance with repeat residual-volume measurement, upper-tract imaging and serum creatinine testing

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

This is chronic urinary retention because the residual volume is repeatedly greater than 1 litre. The necessary safety assessment has already been completed: renal function is stable and upper-tract imaging shows no hydronephrosis. Crucially, his LUTS are non-bothersome and his bladder has not been drained. NICE therefore recommends active surveillance, comprising post-void residual measurement, upper-tract imaging and serum creatinine testing. A is plausible because intermittent catheterisation is generally preferred to an indwelling catheter when catheter drainage is needed in chronic retention, but catheterisation is not mandated here in the absence of renal impairment, hydronephrosis or bothersome symptoms. C is inappropriate because long-term catheterisation is for men for whom surgery is unsuitable, not simply because the residual is large. D would be reasonable for chronic retention with other bothersome LUTS when renal function and the upper tract are normal; this man specifically does not find his symptoms troublesome. E is also attractive given the enlarged prostate, but NICE limits drug treatment to bothersome LUTS, and medication does not replace the recommended surveillance pathway for non-bothersome chronic retention.

Reference: NICE CG97: Lower urinary tract symptoms in men: management — Treating urinary retention (2010) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations