›Broad spectrum antibiotics if sepsis suspected local protocol dependent
Bladder decompression
›Catheterization pathway
›Urethral Foley catheter
›Initial 14 to 18 Fr typical adult size
›Coude catheter if prostatic obstruction suspected
›Drainage monitoring
›Immediate urine output volume
›Hematuria after insertion
›Bladder decompression complications
›Post obstructive diuresis monitoring
›Hypotension after decompression uncommon
Etiology directed treatment
›Benign prostatic hyperplasia suspected
›Alpha blocker example
›Tamsulosin PO 0.4 mg daily
›Orthostatic hypotension risk
›Trial of void timing local protocol dependent
›2 to 3 days after alpha blocker start common practice
›Earlier trial may fail
›Urinary tract infection suspected
›Antibiotics local protocol dependent
›Tailor to local antibiogram
›Adjust for renal function
›Pyelonephritis or sepsis concern
›Parenteral antibiotics local protocol dependent
›Admission consideration
›Constipation contribution
›Disimpaction strategy local protocol dependent
›Osmotic laxative example
›Polyethylene glycol PO 17 g daily
›Avoid if bowel obstruction concern
›Cauda equina syndrome concern
›Immediate MRI spine
›Neurosurgery consultation emergent
Reassessment loop
›Reassessment timing
›Pain reassessment within 30 to 60 minutes
›Urine output reassessment within 1 hour
›Repeat bladder scan if poor catheter drainage
›Post obstructive diuresis monitoring
›Urine output > 200 mL per hour for 2 hours
›Or > 3 L in 24 hours
›Electrolytes every 4 to 6 hours if significant diuresis
17Disposition/dispo24
Level of care criteria
›ICU criteria
›Septic shock requiring vasopressors
›Severe hyperkalemia with ECG changes
›Rapid neurologic decline
›Inpatient admission criteria
›Obstructed infected system
›Acute kidney injury requiring monitoring
›Post obstructive diuresis requiring IV replacement
›Gross hematuria with ongoing clot retention
›Inability to catheterize with persistent retention
›Observation pathway criteria
›Postoperative retention without sepsis
›Stable vitals with moderate retention and clear plan
›Discharge criteria
›Symptom control
›Stable vitals
›Clear catheter function or successful trial of void
›Follow up arranged
Follow up timing
›Urology follow up
›Within 2 to 7 days if discharged with catheter
›Earlier if difficult catheterization or hematuria
›Primary care follow up
›Medication review within 1 to 2 weeks
›Constipation management follow up
18Discharge Instructions/di20
Copy discharge instructions
›Summary
›Urinary retention treated with bladder drainage
›Cause not always clear on first visit
›Catheter care
›Keep catheter and bag below bladder level
›Do not disconnect tubing unless instructed
›Clean around catheter daily with soap and water
›Medications
›Take prescribed medications as directed
›Avoid over the counter cold medicines that can worsen retention
›Fluids and bowel care
›Drink fluids unless told otherwise
›Prevent constipation with fiber and stool softener if recommended
›Return to ED now for
›Fever
›Shaking chills
›New back pain with weakness or numbness
›Catheter not draining for 2 to 3 hours with increasing pain
›Large amounts of blood in urine
›Severe pain not controlled
19References/r12
Guideline and evidence sources
›Urologic retention and lower urinary tract symptoms guidance
›American Urological Association guideline statements on BPH management local protocol dependent
›European Association of Urology guidelines on non neurogenic male LUTS and BPH local protocol dependent
›Neurogenic and spinal emergency guidance
›Neurologic emergency references for cauda equina syndrome evaluation and MRI timing local protocol dependent
›Spine society statements on emergent decompression timing local protocol dependent
›Infection and sepsis guidance
›Surviving Sepsis Campaign guidelines 2021
›IDSA guidance for complicated urinary tract infection and pyelonephritis local protocol dependent
›Diagnostic tool references
›Evidence summaries for post void residual thresholds and bladder scan performance local protocol dependent
›Imaging appropriateness criteria for suspected renal colic local protocol dependent
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.