Urinary Retention

HISTORY:

Urinary retention symptoms for ‍ ‍hoursdays

‍weak urinary stream

‍straining to urinate

‍incomplete bladder emptying

‍nocturia

‍inability to urinate

‍abdominal pain

‍lower back pain

‍burning on urination

‍urinary frequency

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, prostate ‍normal, anus ‍normal

Genital: ‍normal, testicles ‍normal, penis ‍normal

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

Urinary retention due to ‍Benign prostatic hyperplasia ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍creatinine, ‍CRP, ‍PSA

- Urinalysis

- Urine culture

- Renal ultrasound

- CT scan of the abdomen and pelvis

- Post-void residual urine volume

- ‍Alpha-blockers

- ‍5-alpha reductase inhibitors

- Catheterization

- Stop medications that may be causing urinary retention (decongestants, antihistamines, antidepressants, diuretics, opioids)

- Referral to urologist

- Keep catheter in place until urologist appointment

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as fever, hematuria, or urinary incontinence

- Go to ER if unable to urinate or severe lower abdominal pai