An elderly man, 72, was recently hospitalized and has not voided since catheter removal 8 hours ago. He had sigmoid colectomy 2 days ago. He is on IV fluids. He has a temperature of 100.8°F. What is the most likely cause of his inability to void?

An elderly man, 72, was recently hospitalized and has not voided since catheter removal 8 hours ago. He had sigmoid colectomy 2 days ago. He is on IV fluids. He has a temperature of 100.8°F. What is the most likely cause of his inability to void?

• A. Bladder outlet obstruction
• B. Postoperative neurogenic bladder
• C. Urinary retention due to UTI
• D. Overflow incontinence from overdistended bladder

Answer: (A)

The main idea is postoperative urinary retention due to bladder outlet obstruction from benign prostatic hyperplasia. In a 72-year-old man, the prostate can narrow the urethral passage. After the Foley is removed, the bladder still contracts to push urine out, but the narrowed outlet from BPH makes it hard or impossible to void, leading to sudden retention. The scenario fits this pattern: age-related risk, recent surgery with catheter removal, and no voiding for several hours. While other causes are conceivable, they’re less likely here. Postoperative neurogenic bladder would require a disruption of neural control from anesthesia or spinal injury and isn’t as typical in this setting. Urinary retention from a UTI would usually come with infection symptoms and not be the most likely immediate post-catheter-removal issue. Overflow incontinence describes leakage from an overdistended bladder, not an inability to void.

The main idea is postoperative urinary retention due to bladder outlet obstruction from benign prostatic hyperplasia. In a 72-year-old man, the prostate can narrow the urethral passage. After the Foley is removed, the bladder still contracts to push urine out, but the narrowed outlet from BPH makes it hard or impossible to void, leading to sudden retention. The scenario fits this pattern: age-related risk, recent surgery with catheter removal, and no voiding for several hours.

While other causes are conceivable, they’re less likely here. Postoperative neurogenic bladder would require a disruption of neural control from anesthesia or spinal injury and isn’t as typical in this setting. Urinary retention from a UTI would usually come with infection symptoms and not be the most likely immediate post-catheter-removal issue. Overflow incontinence describes leakage from an overdistended bladder, not an inability to void.