SU29.{7,9-10} | Urinary Retention and Prostate Disorders — Summary & Reflection

KEY TAKEAWAYS

Urinary retention is acute (sudden, painful, tender palpable bladder — an emergency relieved by immediate urethral catheterisation, suprapubic if urethral access fails) or chronic (painless, large residual; high-pressure chronic retention causes hydronephrosis and renal impairment). After relieving chronic retention, watch for post-obstructive (post-decompression) diuresis and replace fluids and electrolytes. The commonest cause of retention in older men is benign prostatic hyperplasia. Prostate disease is two diseases told apart by zone of origin: BPH arises in the transition (periurethral) zone and causes LUTS scored by IPSS, with a smooth, rubbery, sulcus-preserved gland on DRE, managed by lifestyle, alpha-blockers (tamsulosin), 5-alpha-reductase inhibitors (finasteride) and TURP as the gold-standard operation; carcinoma of the prostate is a peripheral-zone adenocarcinoma with a hard, nodular, sulcus-lost gland on DRE, a raised (organ-specific) PSA, graded by Gleason/ISUP, diagnosed by PSA + DRE + multiparametric MRI then targeted biopsy, metastasising to bone as osteoblastic lesions (bone scan for staging), and managed by surveillance, radical prostatectomy/radiotherapy, or androgen deprivation therapy for advanced disease. The digital rectal examination — consent, chaperone, left-lateral position, lubricated gloved finger, assess anal tone then size/surface/consistency/sulcus/nodules/tenderness, inspect glove, document — is the bedside test that separates the benign from the malignant gland.

REFLECT

Recall the last time you saw, or imagine being called to, an older man who suddenly cannot pass urine. Would you have confirmed retention by palpating and percussing the bladder, relieved it promptly with a urethral catheter (and known to reach for a suprapubic route if you could not), and recorded the volume drained — and would you have paused before discharge if the volume was large, to watch for post-obstructive diuresis? Now picture performing the digital rectal examination: did you secure consent and a chaperone, position and inspect the patient properly, and systematically assess the gland's size, surface, consistency, sulcus and any nodules — and could you put into words why a hard nodular gland changes the whole plan? Reflect on how confidently distinguishing benign enlargement from carcinoma at the bedside, and explaining the difference to an anxious patient, would change the way you counsel and refer the next man you meet with prostatic symptoms.