[Acute urinary retention: a few simple rules for a successful catheterization].

Area of Science:

• Urology
• Emergency Medicine

Context:

• Acute urinary retention is a frequent urological emergency, particularly in older males.
• Management involves bladder decompression via catheterization, with transurethral and suprapubic routes being common.

Purpose:

• To outline the essential techniques and safety considerations for performing transurethral and suprapubic catheterization in patients experiencing acute urinary retention.
• To provide guidance on managing difficult catheter insertions and potential complications like bleeding.

Summary:

• Transurethral catheterization is indicated when urethral injury is absent, emphasizing local anesthesia and penile stretching for atraumatic placement.
• Difficult insertions may benefit from thicker, rounded, or bent-tip catheters with rectal guidance.
• Suprapubic catheterization is an alternative, requiring absence of contraindications like suspected transitional cell carcinoma and ultrasound guidance for specific patient groups (post-abdominal surgery, hemorrhagic diathesis).
• Persistent bleeding post-suprapubic catheterization necessitates balloon catheter replacement and sustained tension.

Impact:

• Safe and effective management of acute urinary retention, minimizing patient discomfort and procedural risks.
• Improved clinical outcomes through adherence to best practices in catheterization techniques.
• Reduced incidence of complications associated with urinary catheterization in emergency settings.