Chief Emeka arrived at 11 pm unable to pass a single drop of urine despite the most urgent urge of his life. A catheter provided immediate relief. Mascot Healthcare then started him on BPH medication to prevent this ever happening again.
Retired businessman, Agege. Presented at 11 pm unable to pass any urine for 8 hours despite severe urge. Lower abdominal pain and distension. Bladder palpable on examination to the umbilicus — containing approximately 900 mL. Known BPH, not on medication.
Acute Urinary Retention (BPH-related)Chief Emeka had spent 8 hours trying every trick he knew: warm water running, sitting in a warm bath, lying in different positions, praying. Not a drop. By 10 pm his wife was alarmed at the level of his pain. By 11 pm, he agreed to come to Mascot Healthcare.
The doctor could see from across the room that his lower abdomen was distended. On examination, the bladder was tympanic to percussion and palpable 5 cm above the pubic symphysis. "You need a catheter right now," the doctor said. "We'll explain everything after, but this needs to happen immediately."
The catheter was passed smoothly. 850 mL of dark amber urine drained over 3 minutes. Chief Emeka exhaled. "I never want to feel that again," he said.
Acute urinary retention (AUR) is the sudden inability to pass urine — a medical emergency causing intense discomfort and potential kidney damage if not relieved within hours. It is most commonly caused by BPH in older men.
No urine passed in 8 hours despite the most intense urge — even with prolonged straining.
Intense, building lower abdominal pressure and pain from the distended bladder.
On examination, the bladder was palpable and percussed dull to the umbilicus — containing approximately 900 mL.
History of lower urinary tract symptoms for 3 years; had not sought treatment for BPH.
Had taken a nasal decongestant for a cold earlier that day — alpha-agonist decongestants can trigger AUR in BPH patients.
Warm bath — appropriate first attempt; failed to relieve retention.
Running tap water — psychological aid for stream initiation; failed with complete retention.
Prolonged straining — worsened discomfort; no urine produced.
Nasal decongestant (pseudoephedrine) earlier that day — probable precipitant in a patient with underlying BPH.
Urethral catheterisation performed — a 14Fr catheter was passed and 850 mL of urine drained. Immediate and complete pain relief. Catheter left in situ overnight; trial without catheter (TWOC) arranged for the following morning.
In the interim: blood tests (renal function — creatinine mildly elevated at 108 μmol/L, recovering to normal after drainage); medication to relax the prostatic smooth muscle was started immediately. TWOC the next morning: successful.
Long-term plan: ongoing medication for BPH; urology referral for assessment of surgical options given the severe AUR episode; advice to avoid all decongestants, antihistamines, and anticholinergics.
Acute Urinary Retention — precipitated by alpha-agonist decongestant in patient with established BPH (bladder volume 850 mL; creatinine mildly elevated; TWOC successful)
Emergency urethral catheterisation; overnight catheter; TWOC next morning (successful); medication for BPH; urology referral; decongestant/antihistamine avoidance
Successful TWOC. Creatinine normalised at 48 hours. Urological assessment arranged for BPH surgical options.
Successful trial without catheter. No further AUR episodes on BPH medication at 3-month follow-up. Urology assessment underway.
Acute urinary retention is a medical emergency — do not wait at home for hours hoping it resolves. Any man who cannot pass urine for more than 4 hours needs a catheter.
Men with BPH should never take decongestants (pseudoephedrine, phenylephrine) or some antihistamines without medical advice — they can precipitate acute retention. BPH that is left untreated leads to emergencies like this.
Can't pass urine for 4 hours despite trying? Don't wait — come in immediately. A catheter fixes it in minutes.
Walk in to Mascot Healthcare, Akoka — same-day consultation, transparent pricing, 4.9★ rated.