60 yrs old male with poor stream of urine, post void residual urine is 400m1, b/1 hydronephrosis and prostate weighing 70 g. His urea is 120 and creat 3.5. Ideal "next immediate" step :
Ans is 'a' i.e. Catheterize with Foley catheter "Catheterization is mandatory for acute urinary retention. Spontaneous voiding may return, but a catheter should be left indwelling for 3 days while detruson tone returns."- CSDT I3/e This is a case of bladder outlet obstruction most likely due to BHP (can also be due to ca). So the immediate next step is to drain the bladder a transurethral Foley catheter. If this fails suprapubic drainage can be done.
Catheterize with Foley catheter
b/1 PC Nephrostomies
CT to rule out ca
MRI pelvis