Episode 55 -Management of Acute Urinary Retention in the Emergency Department

Acute urinary retention requires a systematic emergency department approach starting with ultrasound confirmation and immediate mechanical bladder drainage. When standard Foley catheterization fails, clinicians should escalate to coude or silicone catheters before considering suprapubic catheter placement, a procedure easily performed using a Seldinger technique. Rapid bladder decompression is safe and does not necessitate clamping, while prophylactic antibiotics offer no clinical benefit and increase microbial resistance. Post-procedure care involves monitoring for post-obstructive diuresis and initiating alpha-blockers to improve voiding success. Beyond mechanical relief, clinicians must investigate underlying etiologies—including medications, drugs of abuse, and neurological or structural pathologies—to ensure appropriate long-term management. Patients should ideally secure urological follow-up within three days to facilitate successful voiding trials and minimize complications.