What are the initial assessment steps for a patient presenting with acute urinary retention in primary care?

Initial assessment steps for a patient presenting with acute urinary retention in primary care include:

• Take a focused history to understand the onset, duration, and any precipitating factors of the retention episode.
• Perform a physical examination including abdominal examination to check for bladder distension and an examination of the external genitalia.
• In men, consider a digital rectal examination to assess the prostate, especially if lower urinary tract symptoms (LUTS) are present or suspected.
• Immediately catheterise the patient to relieve retention and prevent complications.
• Offer an alpha blocker to men for managing acute urinary retention before removal of the catheter.
• Review current medications and comorbidities that may contribute to urinary retention.
• Consider referral for specialist assessment if retention is complicated, recurrent, or associated with other concerning features such as infection or renal impairment.

Routine imaging, flow-rate measurement, or post-void residual volume measurement are not recommended at initial assessment in primary care unless clinically indicated.

Provide reassurance and advice on lifestyle interventions as appropriate.

These steps align with NICE guidance on managing lower urinary tract symptoms and acute urinary retention in men and women in primary care settings.

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