What is the initial management for acute urinary retention in a male patient?

• A. Observation and reassessment after monitoring
• B. Immediate catheterization to relieve retention
• C. Start antibiotics and hydration
• D. Ureteral stenting

Answer: (B)

The key idea is to rapidly decompress the bladder. In acute urinary retention, the immediate step is catheterization to relieve the obstruction and evacuate urine. This relieves pain, prevents bladder overdistension and potential detrusor muscle injury, and protects kidney function from back-pressure effects like hydronephrosis or post-renal acute kidney injury. Once the bladder is decompressed, you can assess and manage the underlying cause (such as BPH, urethral stricture, medications, or infection) and plan longer-term treatment. Observation wouldn’t provide relief or protect the kidneys, antibiotics and hydration don’t address the blockage, and ureteral stenting targets the ureter rather than bladder outlet obstruction, so it isn’t the initial management.