A 79-year-old man with a history of prostate cancer is brought to the emergency department because of lower abdominal pain for 1 hour. He has not urinated for 24 hours. Abdominal examination shows a palpable bladder that is tender to palpation. A pelvic ultrasound performed by the emergency department resident confirms the diagnosis of acute urinary retention. An attempt to perform transurethral catheterization is unsuccessful. A urology consultation is ordered and the urologist plans to attempt suprapubic catheterization. As the urologist is called to see a different emergency patient, she asks the emergency department resident to obtain informed consent for the procedure. The resident recalls a lecture about the different modes of catheterization, but he has never seen or performed a suprapubic catheterization himself. Which of the following statements by the emergency department resident is the most appropriate?
A“I would prefer that you obtain informed consent when you become available again.”
B“Suprapubic catheterization is not the treatment of choice for this patient.”
C“I would be happy to obtain informed consent on your behalf, but I'm not legally allowed to do so during my residency.”
D“I will make sure the patient reads and signs the informed consent form.”
E“I will ask the patient to waive informed consent because this is an urgent procedure.”
A 19-year-old man is brought to the emergency department following a high-speed motor vehicle collision in which he was a restrained passenger. He complains of pelvic pain and urinary retention with overflow incontinence, along with associated lower extremity weakness. Examination shows perineal bruising and there is pain with manual compression of the pelvis. Injury to which of the following structures is most likely responsible for this patient's urinary incontinence?
AIlioinguinal nerve
BObturator nerve
CGenitofemoral nerve
DPelvic splanchnic nerves
ESuperior gluteal nerve
A 40-year-old woman was admitted to the surgical service after an uncomplicated appendectomy. She underwent surgery yesterday and had an uneventful postoperative course. However, she now complains that she is unable to completely void. She also complains of pain in the suprapubic area. You examine her and confirm the tenderness and fullness in the suprapubic region. You ask the nurse to perform a bladder scan, which reveals 450cc. What is the next appropriate step in management?
ACatheterization
BOral bethanechol chloride
CNeostigmine methylsulfate injection
DIntravenous furosemide
EIntravenous neostigmine methylsulfate
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