Pharmacological Relief of Acute Urinary Retention in a Remote Environment

BACKGROUND: In spaceflight, acute urinary retention (AUR) could develop as a sequela of medication use, urinary tract infection, urolithiasis, or intentional urine holding. While AUR is generally treated with bladder decompression, urinary catheterization could be difficult operationally in terms of training and proficiency, supplies, and lack of space or privacy. This report discusses a case in which tamsulosin and lorazepam were used successfully on an offshore ship while awaiting medical evacuation, a situation that could arise in remote locations where aerospace operations are conducted.CASE REPORT: A 52-yr-old man with hypertension and obstructive sleep apnea but no formal diagnosis of benign prostatic hyperplasia was unable to urinate for over 16 h while on a deep-sea fishing vessel approximately 200 nmi offshore. By phone, the physician providing remote medical direction diagnosed AUR in the setting of possible infection and prescribed acetaminophen, ciprofloxacin, and a trial of tamsulosin as the ship did not have any medical personnel trained to perform urinary catheterization and there were no catheter supplies available. Lorazepam was later added for anxiolysis and potential smooth muscle relaxation. Within 1 h of initial medication administration, the patient successfully voided a large quantity of urine, which tested positive for infection by urine dipstick. The patient was continued on antibiotics and evacuated to a medical facility onshore for further management.DISCUSSION: Pharmacological treatment could be considered as a temporizing measure where operational constraints limit the ability to perform urinary catheterization to relieve acute urinary retention.Law J, Cardy V.