Why Can’t House Pee?

In the episode of House MD S3E16 “Top Secret”, Dr. House has a dream about being in the Marines and being with a certain person. This same patient then shows up in his hospital, leading House to try and put the pieces together. However, House is having difficulty peeing, leading to an interesting conversation between him and his friend. In this article, we’ll discuss urinary retention, the causes, and how to treat it.

What is Urinary Retention?

Urinary retention is the sudden inability to empty your bladder which is accompanied by some suprapubic discomfort or lower abdominal pain which is where your bladder sits. There can be a lot of different causes for this, including narcotics or other medications that can make it harder for your bladder to empty, obstruction which can be due to a large prostate or any sort of stricture or narrowing of the urethra, and detrusor underactivity which basically means that your bladder isn’t squeezing strongly enough. This can be due to a number of different reasons, very commonly it’s due to neurologic disorders or having a long-standing disease like diabetes which can cause the bladder over time to become less strong and squeeze less strongly.

Treatment of Urinary Retention

The next step for someone who has acute urinary retention would be to place a urethral catheter or a foley catheter. This is a small tube that goes through the penis and into the bladder and is typically the easiest and most straightforward way to empty a bladder and achieve immediate relief. You can place your own catheter, which is called clean intermittent catheterization. If you get a catheter in the hospital, typically you will have a sterile space so they will place special sterile gloves on, they will clean the tip of the penis or the tip of the urethra with some betadine or some soap specialized soap that can help make sure all the bacteria are gone and place the catheter that way.

Alpha blockers, such as alfuzosin, or tamsulosin work by relaxing the smooth muscle of the prostate which sits right around the urethra underneath the bladder and this can then make it difficult for men to urinate when it gets too big or obstructs the passageway from urine to pass.

Post-Obstructive Diuresis

If someone has been in retention for several days, they are at risk for post-obstructive diuresis. This is when someone makes over two liters of urine when they empty their bladder with a catheter, or they make over 200 cc’s or 200 ml every hour for over three hours. These people are at risk for having metabolic changes, meaning their sodium levels in their blood can change and that can cause some mental abnormalities or cognition changes. Typically, these people are admitted to the hospital, they get IV fluids and they get monitored with their blood pressure, their heart rate, and they get their blood checked every six to 12 hours to make sure that their electrolytes are not becoming abnormal.

Conclusion

In this episode of House MD, we saw an interesting conversation between House and his friend about urinary retention. We discussed the causes of urinary retention, how to treat it, and the risks of post-obstructive diuresis. It’s important to remember that if you are having difficulty urinating, you should see a regular physician who is managing your pain control and not get medications from friends.

If you’d like to learn more about urinary retention and how to place a catheter, check out this video from the New England Journal of Medicine.