Acute Urinary Retention Guidelines – are they Worth it?

Abstract

Objective Many district general hospitals in the UK do not have 24-hour urology cover and the junior doctors admit almost all patients with acute urinary retention (AUR) unnecessarily. A small retrospective audit involving a random selection of 17 patients who initially presented with AUR to accident and emergency (A&E) and eventually underwent transurethral resection of the prostate (TURP) between January 2002 and May 2002 showed that four (23%) were admitted unnecessarily and only a few patients had digital rectal examination and antibiotic prophylaxis. Guidelines were prepared to assist the junior doctors in managing patients with AUR. The guidelines were audited to assess how they worked. Methods A total of 32 patients with AUR were managed using the guideline from June 2002 to December 2002 and the details were collected prospectively from A&E referral letters; three patients were excluded. Results After implementation of the guideline, the majority of patients went home with a catheter (86%), and the number of digital rectal examinations had not increased but antibiotic prophylaxis had improved from 11 to 38%. The number of records of residual urine remained unchanged and residual urine was not documented in seven patients. Therefore, it was not known whether they had very high residual urine needing admission. More patients received alpha-blockers (27%). There were no inappropriate admissions. Conclusion Patients with uncomplicated urinary retention can be managed without admission. Development of guidelines avoids inappropriate admissions and improves efficiency. Education and training of junior doctors in the management of AUR is an absolute necessity to implement these guidelines.