Acute urinary retention

Acute urinary retention: A case of successful catheterization in an elderly patient.

A 75-year-old man presented to the emergency department of the hospital, experiencing the need to press on his lower abdomen to empty his bladder and relieve symptoms.

The patient complained of increased urination, weak thin stream, sensation of incomplete bladder emptying, general malaise, weakness, and loss of appetite. Occasionally, urine only dribbled out, requiring manual assistance. He took non-steroidal anti-inflammatory drugs for headaches and abdominal pain.

Medical History:
Relatives noticed the patient had been urinating more frequently for the past six months, but he denied it, believing the symptoms lasted about a month. Three days before seeking help, he couldn’t urinate without assistance, prompting him to see a urologist. He sometimes had high blood pressure, for which he took Capoten. He had never visited a urologist before and was not under the care of any specialists.

The man was in a serious condition, with pale-pink skin. His tongue was clean and dry. He had an elongated physique with long arms and legs. The abdomen was soft, participating in breathing, and palpation of the lower areas was painful. There were no signs of peritonitis. The bladder was palpable above the groin. Tapping on the lumbar region was painless. The liver was not enlarged.

Prostate hyperplasia. Paradoxical ischuria, where urine leaks from an overfull bladder but the patient can’t urinate. Chronic complete urinary retention. Hydronephrosis on both sides. Acute kidney injury.

In the emergency department, a Foley N20 urethral catheter was inserted, draining more than 1300 ml of light urine. Due to severe azotemia (elevated creatinine and urea levels) and the severity of his condition, the patient was hospitalized in the intensive care unit, where he received conservative and infusion therapy.

After three days of treatment, his creatinine level dropped to 100 µmol/l and urea to 8 µmol/l. He was transferred to the urology department, where he underwent a trocar cystostomy – a procedure to create an artificial channel for urine drainage.

This clinical case underscores the importance of timely urological intervention. Unfortunately, elderly people with similar symptoms often delay seeking medical help, emphasizing the importance of relatives advocating for examinations to prevent complications and more severe treatment.