Acute urinary retention in males

Please note the final box regarding the TWOC referral pathways is inaccurate in this flowchart (as of July 2024): please see the patient disposition section below.

• Do not use an introducer
• Proper aseptic technique
• Size 14 or 16 Foley catheter, no bigger
• Anaesthetise urethra with Lignocaine gel allowing it at least 5 minutes to work. This is the most important key to success and patient comfort.
• Gently and slowly (to prevent spasm of the urogenital diaphragm) introduce the catheter.
• Only inflate the balloon when you are sure you are in the bladder - urine is trickling from the catheter.
• Take off a CSU. Dipstick: if positive for nitrites/leucocytes send for culture and start antibiotics per the antibiotic guidelines
• The bladder may be allowed to rapidly decompress in acute retention
• Measure and document the drained retention urine volume, 15 minutes after catheterization
• If there are problems involve senior, or discuss with urology
• If failed on first attempt, can try using a different size catheter for 2nd attempt
  • If no further success after this, discuss with registrar/consultant or refer to urology

• Check urea, creatinine and electrolytes. Do not measure PSA.
• Abdominal examination including digital rectal examination

If catheterisation was unsuccessful:

• Check if there is a registrar or consultant who maybe able to have another attempt
• Seek advice from the on-call urology registrar at WGH - the next step should be supra-pubic catheterisation.
• Do not attempt to use an introducer
• Minimise multiple attempts to prevent damage to the urethra

If catheterisation was successful:

• See the trial without catheter (TWOC) page

The RIE has a similar guideline on their intranet (backup copy for reference)