The Management of Acute Urinary Retention

A54-year-old male with diabetes presents to the emergency room with 5 days of abdominal distension and pain. He is tachycardic but afebrile. Physical examination reveals a severely distended, though non-tender, abdomen and an enlarged prostate. No focal neurologic deficits are appreciated. Laboratory results show a leukocytosis of 18.1 K/mm3, a lactate of 4.9 mmol/L, and a potassium of 6.6 mmol/L. Serum creatinine is 10.4 mg/dL with an eGFR of 5 mL/min/1.73 m2. There is nephrotic range proteinuria on urinalysis. Vitamin B12 levels are normal and his hemoglobin A1c is 5.6%. Prostate-specific antigen is 0.93 ng/mL. Computed tomographic imaging is shown below (Fig. 1). A. Insert catheter, admit for post-obstructive diuresis. B. Bilateral percutaneous nephrostomy tubes. C. Suprapubic tube placement and outpatient urology follow up.