Chronic urinary retention

Usually not painful. May be hard to diagnose, typically patients have a palpable bladder and deny any voiding problems.

Catheterisation needs to be done but should not be carried out in the ED. A chronically distended urinary tract can cause acute bleeding on decompression or a massive diuresis with ensuing electrolyte abnormalities.

Check U&Es as the patient may be in renal failure. If abnormal bloods refer to urology for emergency admission, otherwise urgent outpatient referral to Urology at St John’s.