The Management of Acute Urinary Retention

A 54-year-old male with diabetes presents to the emergency room with 5 days of abdominal distension and pain. He is tachycardic but afebrile. Physical examination reveals a severely distended, though non–tender, abdomen and an enlarged prostate. No focal neurologic deficits are appreciated. Laboratory results show a leukocytosis of 18.1 K/mm3, a lactate of 4.9 mmol/L, and a potassium of 6.6 mmol/L. Serum creatinine is 10.4 mg/dL with an eGFR of 5 mL/min/1.73 m2. There is nephrotic range proteinuria on urinalysis. Vitamin B12 levels are normal and his hemoglobin A1c is 5.6%. Prostate-specific antigen is 0.93 ng/mL.