The EM Educator Series: The Patient Who Can’t Pee

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 59-year-old male presents with severe lower abdominal pain and inability to pass urine for over 12 hours. On ultrasound, you find a significantly distended bladder, with approximately 1 L of urine.

Case 2:

A 23-year-old female presents with suprapubic and pelvic pain. She has not wanted to urinate due to severe pain from a rash that started several days ago.

Considerations:

• What are the etiologies of urinary retention in males and females?
• How does urinary retention present?
• What labs should be obtained?
• What is the utility of imaging?
• What is the ED management, including Foley catheter, coude catheter, suprapubic catheter, and bladder irrigation?
• Are there complications of postobstructive diuresis?
• Who needs emergent urologic consultation?

Suggested Resources:

• Articles
  • emDOCs – Urinary Retention
  • Emergency Medicine Cases – Female Urinary Retention
  • REBEL EM – Rapid or Gradual Drainage to Avoid Complications
• Journal Articles
  • Emergency Medicine Practice
  • Surg Clinics North America – Urologic Emergencies
  • Journal of Emergency Medicine – Urinary Retention