Synopsis
Relieve acute bladder retention safely while identifying urethral injury, neurological disease, infection and complications that alter immediate management.
- Confirm an overfilled bladder: inability to pass urine with an empty bladder may reflect low urine production instead.
- Pelvic trauma with blood at the meatus needs urgent assessment for urethral injury and specialist drainage planning before routine blind catheterisation.
- Use aseptic technique, appropriate catheter length and lubrication, and confirm intravesical placement before balloon inflation.
Investigation priorities
Confirm distension and distinguish retention from anuria or a misleading pelvic fluid collection.
Management branches
An adult has a distended painful bladder without an identified urethral contraindication.
- Review allergy to latex, lidocaine and chlorhexidine, previous instrumentation and implanted continence devices. Prepare sterile equipment, a suitable adult catheter and closed drainage system, then position and explain each stage to the patient.
- Clean the meatus, instil the selected sterile lubricant and allow its stated anaesthetic onset. In a male urethra advance a standard-length catheter gently to the bifurcation after urine returns; a female-length catheter must never be used in a man. For a female urethra, the EAUN procedure advances approximately another 2 cm after urine appears.
Key medicines
Instillagel urethral gelFor adult urethral catheterisation, instil 6–11 ml once: the EAUN female procedure uses 6 ml, while a male application may use the 11 ml syringe. Allow about five minutes for anaesthesia; administer into the urethra, never by injection.Avoid with lidocaine, chlorhexidine or constituent allergy, or damaged or bleeding mucosa. The 11 ml syringe contains 230 mg lidocaine hydrochloride. Consider cumulative local anaesthetic exposure, cardiac or hepatic disease, epilepsy and antiarrhythmics before further administration. First-trimester use requires absolute necessity; do not import an injectable lidocaine maximum.
Tamsulosin 400 microgram prolonged-release capsule400 micrograms orally each day after the first meal, swallowed whole, started before the planned trial without catheter. Review ongoing need after the trial and subsequent symptom assessment.This male BPH-associated regimen is not routine treatment for female or neurogenic retention. Avoid orthostatic hypotension history and severe hepatic insufficiency; use caution with creatinine clearance below 10 ml/min. Do not initiate when cataract or glaucoma surgery is scheduled; tell ophthalmology about past or ongoing exposure.