What are the recommended interventions for managing acute urinary retention in patients with a history of benign prostatic hyperplasia?

Recommended interventions for managing acute urinary retention in patients with a history of benign prostatic hyperplasia (BPH):

• Immediate catheterisation: Men presenting with acute urinary retention should be catheterised immediately to relieve the retention.
• Alpha blocker therapy: Offer an alpha blocker to men for managing acute urinary retention before removal of the catheter to improve the chance of successful trial without catheter.
• Further management: After initial catheterisation and alpha blocker therapy, consider intermittent self- or carer-administered catheterisation before offering long-term indwelling catheterisation, especially if chronic retention develops.
• Assessment and monitoring: For men with chronic urinary retention (residual volume >1 litre or palpable bladder), carry out serum creatinine testing and imaging of the upper urinary tract to assess for complications such as impaired renal function or hydronephrosis.
• Surgical options: Surgery may be considered if catheterisation and medical management fail, but only after specialist assessment and discussion of risks and benefits.

These interventions are based on NICE CG97 recommendations for managing lower urinary tract symptoms and urinary retention in men with BPH ¹.