This can be very difficult to manage without specialist input. And will be particularly difficult to diagnose by remote consulting during the Covid-19 pandemic. Chronic retention should be suspected if a patient complains of new nocturnal enuresis, abdominal distension or a strong sensation of incomplete emptying. Diagnosis can only be made by abdominal palpation and/or percussion, or via trans-abdominal ultrasound of post void residual volume.
There are a range of options:
- Manage in primary care, with prescription of an alpha blocker (suitable for those with mild symptoms, no complicating factors such as recurrent urinary tract infection, stable renal function (assessment of renal function in a patient with chronic retention would be suitably urgent to perform this despite current restrictions on routine blood testing);
- Teaching the patient intermittent self-catheterisation (may be possible via local continence service even during pandemic);
- Indwelling urethral catheterisation – this may be required for high volume chronic retention (detected on renal ultrasound with hydronephrosis and ureteric dilatation in presence of chronic urinary retention) or if evidence of impaired renal function.
Beware however the risk of post catheterisation diuresis (after insertion of indwelling catheter) which can cause significant problems with fluid balance and electrolyte disturbance and consider speaking to your local on call urologist before undertaking this.
All men with chronic urinary retention require urological referral – an urgent referral is appropriate for men with a palpable / percussable bladder, or a post void residual on scan of approximately 500ml or greater.
Dr Jon Rees is a GPSI in urology in Somerset and chair of the Primary Care Urology Society
