Urinary Retention Evaluation & Catheterization Algorithm (URECA)
When to bladder scan, volumes that prompt a catheter, and when intermittent catheter is preferred to indwelling.
Tobias Kohler, Jennifer Glen
Provided by
EVAL FoundationInstructions
- Algorithm intended for adults in the inpatient setting.
- Cut offs were determined based on a combination of literature review, expert opinion, and local practice patterns.
- Use of external catheters to treat urinary retention is inappropriate as external catheters only collect spontaneously voided urine.
- Persistent urge to void or small volume voids
- Fullness
- Bladder pain
- New incontinence/leak
An adult inpatient urinary retention evaluation and catheterization algorithm was developed to improve patient safety by increasing appropriate use of bladder scanners and catheterization. This algorithm addresses the need for practical guidance to manage urinary retention among adult inpatients. The algorithm includes guidance on when to bladder scan, what bladder scanner volumes should prompt catheterization, and when intermittent catheterization is preferred to indwelling catheterization. The algorithm was established based on a using a systematic, multidisciplinary, evidence- and expert opinion–based approach mixed-methods study using the RAND/UCLA Appropriateness Method and qualitative interviews (Chrouser et al, 2024).
All questions & possible results
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Does the patient have one or more of the following physical symptoms of urinary retention?
- Persistent urge to void or small volume voids
- Fullness
- Bladder pain
- New incontinence/leak
Select one option:
- Yes
- No
Perform bladder scan. What are the results of the bladder scan for a symptomatic patient?
Select one option:
- ≤ 300 ml
- > 300 ml
Has it been > 4 hours since the last void or do you have an order to check post-void residual?
- Consider checking sooner if patient getting high IV fluid volumes or receiving diuretics.
Select one option:
- Yes
- No
Perform bladder scan. What are the results of the bladder scan for an asymptomatic patient?
Select one option:
- ≤ 500 ml
- > 500 ml
Request catheter order if needed. Is the patient high risk for a difficult catheter insertion based on the following symptoms?
- Recent bladder, urethral, or prostate surgery, or trauma or prostatitis
- History of urethral stricture, false passage, or neobladder
- History of genitourinary reconstructive surgery
- Artificial urinary sphincter (AUS)
Select one option:
- Yes
- No
Discuss with Urology. Did Urology determine that the patient is high risk?
Select one option:
- Yes
- No
Does the patient have any of the following history?
- History of difficult catheter insertion by record or patient report
- Male patient over age 55, enlarged prostate or history of prostate cancer
- History of pelvic flour prolapse or bladder support surgery
Select one option:
- Yes
- No
Possible results
Patient is NOT high risk. Catheterize with intermittent technique using standard procedure.
Catheterize with Intermittent Technique (Preferred over Indwelling) Unless:
- Inadequate bladder emptying every 4 hours or
- Repeated large bladder volumes retained (e.g., ≥500 ml every 4 hours) or
- Patient anticipated to need catheterization at home & ISC not feasible
High Risk Patient. Catheterize with intermittent technique with special considerations.
Catheterize with intermittent technique (Preferred over Indwelling) unless:
- Inadequate bladder emptying every 4 hours or
- Repeated large bladder volumes retained (e.g., ≥500 ml every 4 hours) or
- Patient anticipated to need catheterization at home & ISC not feasible
Since patient is high risk consider:
- Having a nurse experienced in difficult catheterization catheterize the patient
- Asking patient what has worked for them in the past (e.g., type and size)
- Obtaining order for anesthetic gel for insertion
- If high-risk male, obtain 16 or 18 French Coude urethral catheter
Wait 1-2 hours and reassess.
Consider:
- Evaluate patient's fluid intake and consider increasing fluids.
- Call provider if urine output is <35ml/hour and raise concern for oliguria from hypovolemia or acute kidney injury.
No bladder scan needed.
Symptoms and void residual do not indicate a need to perform a bladder scan at this time.
Consider other causes and rescan in 1-2 hours.
Other common causes of these urinary symptoms include:
- UTI
- Overactive bladder
- Small bladder capacity
- Recent catheterization
Consider contacting provider for further evaluation.
Literature
- Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients. JAMA Netw Open. 2024;7(7):e2422281. doi:10.1001 — Kristin Chrouser, Karen E. Fowler, Jason D. Mann, et al
