DRIUrology clinical guide
Draft clinical resource — local clinical approval required before intranet publication

Urology Emergency management

Acute urinary retention

Immediate bladder drainage, assessment and safe disposition for adults presenting to DRI ED.

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Acute urinary retention flowchart

  1. Unable to void + painful/palpable bladderAssess ABCDE, confirm retention clinically or with bladder scan when uncertainty exists, and look for sepsis, AKI, neurological deficit, recent surgery or trauma.
  2. Possible urethral injury or complex postoperative case?Blood at the meatus, pelvic/perineal trauma, abnormal genital examination or recent urethral/urological reconstruction.
  3. Yes — do not make blind repeated attemptsUrgent senior/Urology advice and an agreed drainage plan.
    No — catheterise immediatelyAseptic urethral catheterisation by a competent clinician; document catheter, urine and residual volume.
  4. Catheter draining?Check pain relief, drainage, haematuria, renal function and post-obstructive diuresis risk.
  5. Yes — reassess dispositionAdmit or discuss if unwell, AKI, bleeding, neurological features or high residual/diuresis risk; otherwise arrange catheter care, safety-netting and follow-up.
    No — Failed catheterisationStop repeated traumatic attempts and contact the Surgical SHO/Urology team promptly.

Focused assessment

History

  • Previous LUTS/retention, urethral stricture, prostate disease or catheter problems
  • Constipation, infection symptoms and precipitating medicines
  • Back pain, leg weakness, saddle sensory change or altered bowel function

Examination

  • Observations, hydration and sepsis screen
  • Distended/tender bladder; external genital and meatal abnormality
  • Focused neurological examination and rectal examination when clinically indicated

Investigations

  • Bladder scan if diagnosis or residual is uncertain
  • Urinalysis; culture if infection suspected
  • U&E/creatinine, with FBC/CRP and imaging according to complications

Immediate actions

  1. Catheterise immediately. Use an appropriate urethral catheter and aseptic technique.
  2. Record urine drained, residual volume, urine appearance and observations. Check renal function; add other investigations according to the clinical picture.
  3. Look for sepsis, acute kidney injury, neurological features, recent urological surgery, trauma, haematuria or difficult catheterisation.

After successful catheterisation

Admit or obtain urgent senior advice

Systemically unwell, sepsis, significant haematuria, acute kidney injury, neurological red flags, post-obstructive diuresis risk, inability to manage safely at home, or another complicating feature.

The supplied local pathway uses residual >1500 mL and/or abnormal creatinine as a DRI SAW admission trigger. This threshold requires current DBTH confirmation.

Potential discharge pathway

Clinically stable, uncomplicated presentation, catheter functioning, follow-up and catheter care arranged, and no admission criterion after senior/local-pathway review.

For men, NICE CG97 recommends offering an alpha blocker before catheter removal. Prescribe against current contraindications and local formulary guidance.

Failed urethral catheterisation

Stop repeated traumatic attempts. Escalate promptly to an experienced clinician and the Surgical SHO or Urology on-call team. Document attempts, catheter types, bleeding and current bladder discomfort.

The supplied document describes needle bladder aspiration when help is unavailable. This is not included as a routine ED action because a current supporting DBTH procedure has not been supplied.