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A 70-year-old man presents with a 12-hour history of not being able to pass urine. He has had problems in the past with his ‘waterworks’ and has noticed that his stream is very slow and barely reaches the pan of the toilet. He has no significant co-morbidities. On examination he has a palpable bladder and his genitals are entirely normal. Examination of his prostate reveals a 60-g benign-feeling prostate. You diagnose him with acute urinary retention.
1. What catheter would you use and why?
Using the principles set out in Chapter 17, Catheters, we can identify the correct catheter based on catheter size, number of channels, tip design and material.
So, in summary, the patient needs a size 14–16 Fr, two-way Foley, PTFE catheter.
Two days later he returns to the hospital to have a trial without catheter. Unfortunately, he is unable to pass urine and develops supra-pubic discomfort and a palpable bladder. He needs a catheter while he awaits a definitive procedure in 6 weeks’ time.
2. Using the same principles as before, describe what catheter you would use?
A 14–16 Fr, two-way Foley, hydrogel or silicone catheter, which can be kept in place for up to 3 months.
3. What definitive procedure is he going to have and what are the risks?
Transurethral resection of the prostate (TURP). The risks can be split into common, occasional and rare.
4. What is TUR syndrome?
TUR syndrome presents with mental confusion, nausea, vomiting, hypertension, bradycardia and visual disturbances. It occurs as a consequence of the absorption of large amounts of 1.5% glycine which is sometimes used in monopolar TURP and TURBT as an irrigant solution. The excessive absorption results in: (i) dilutional hyponatraemia, (ii) fluid overload, (iii) glycine toxicity.
5. What factors were found to have an influence on the risk of developing TUR syndrome?
The time of the resection (>90 minutes) and size of the gland (>45 g). The risk of TUR syndrome is reduced by using saline as an irrigant as is the case in bipolar TURP.