Urinary retention: catheter care, self-catheterisation and Aquablation

Being unable to pass urine can be frightening. Being told you need a catheter can bring a different set of worries: will it hurt, how will you manage at home, and will you need it forever?

A catheter helps your bladder drain while your healthcare team works out what is causing the problem. Some people need one briefly; others need longer-term support. Understanding your options can make the next steps feel more manageable.

What is urinary retention?

Urinary retention means your bladder cannot empty properly. It can affect both men and women.

Over time, retention can contribute to infections, overstretch the bladder and sometimes damage the kidneys. Passing some urine does not necessarily mean your bladder is emptying safely. A particularly important form is high-pressure chronic retention.

Source: NIDDK: types and complications of retention.

What causes it?

There may be a blockage, a bladder muscle that does not squeeze effectively, or both. In men, an enlarged prostate is a common cause. Other possibilities include a narrowed urethra, constipation, infection, pelvic organ prolapse, and nerve problems associated with conditions such as diabetes or spinal disease.

Retention can also happen after an operation or with certain medicines. Ask for a medication review rather than stopping prescribed treatment yourself.

Possible warning signs include a weak stream, difficulty starting, frequent small wees, leakage and feeling incompletely empty. These symptoms have several possible causes, so assessment matters.

Source: NIDDK: symptoms and causes.

Protecting kidney function

High-pressure chronic retention: when the kidneys are at risk

High-pressure chronic retention develops when the bladder remains overfull and pressure stays too high. This pressure can affect drainage from the kidneys, causing swelling called hydronephrosis and deterioration in renal function — how well the kidneys filter the blood.

It can develop quietly. You may still pass some urine or have leakage, with little pain. Feeling reasonably comfortable does not rule out kidney damage.

Why prompt treatment matters

Retention with worsening kidney function or hydronephrosis needs urgent urological assessment and prompt bladder drainage, usually with a catheter. Blood tests and an ultrasound help assess the effect on the kidneys. This should not wait for a routine appointment or for tablets to take effect.

After drainage, some people produce unusually large amounts of urine. The team may need to monitor urine output, fluid balance and blood salts, sometimes in hospital.

Sources: Norfolk and Norwich NHS: high-pressure retention and monitoring after drainage and NICE: retention affecting kidney function.

When might bladder outflow surgery be necessary?

Once the bladder has been drained and your condition stabilised, surgery to relieve bladder outlet obstruction may be necessary to protect the kidneys and reduce the risk of further retention. This is particularly important when an enlarged prostate is causing back-pressure on the kidneys or deterioration in kidney function.

Depending on the cause and your assessment, options may include TURP, HoLEP or Aquablation in suitable patients. The choice depends on prostate anatomy, bladder function and fitness for surgery. If surgery is unsuitable, an ongoing drainage plan is needed.

The aim is to relieve obstruction and protect kidney function. Kidney function may improve after treatment, but full recovery and being able to manage without a catheter cannot be guaranteed. Follow-up blood tests and scans may still be needed.

Guidance: European Association of Urology: indications for surgery and treatment selection.

Finding the cause

What happens at an assessment?

Your clinician will ask about symptoms, medicines, bowel habits, previous surgery and other health conditions. A bladder scan can measure how much urine remains after you try to pass urine.

You may need urine and kidney blood tests, an examination and an ultrasound of the kidneys. A flow test, a camera examination called cystoscopy, or bladder pressure tests called urodynamics may help clarify the cause. Not everyone needs every test.

Source: NIDDK: diagnosing retention.

Draining the bladder and planning ahead

Acute retention usually needs immediate catheter drainage. For chronic retention, treatment depends on symptoms, bladder function and whether the kidneys are affected. Monitoring is an option for selected stable patients; retention affecting the kidneys needs prompt drainage and specialist care.

When prostate obstruction is suspected, a medicine such as tamsulosin may help relax the outlet before catheter removal. Medicines that shrink an enlarged prostate work more gradually. Your clinician will explain suitability and side effects.

Source: NICE: managing retention and male urinary symptoms.

What is a trial without catheter?

A trial without catheter (TWOC) is a planned check to see whether you can empty your bladder after the catheter is removed. Staff assess the urine you pass and usually check your bladder with a scanner.

If emptying is still inadequate, another catheter or intermittent self-catheterisation may be needed while the next steps are agreed. This does not automatically mean you will always need a catheter. Follow your team’s removal plan; do not remove one yourself unless you have specifically been taught and asked to do so.

With high-pressure retention affecting the kidneys, catheter removal should be specifically agreed by the urology team, so that harmful pressure does not build up again.

Source: Kingston and Richmond NHS: trial without catheter.

Understanding the different catheters

Source: NHS: catheter types.

Confidence at home

Everyday catheter care

Your nurse should demonstrate your equipment and provide supplies, contact details and a replacement schedule.

• Clean hands first. Wash before and after handling the catheter, bag or valve.
• Wash gently each day. Use mild soap and water around the entry area, following any specific wound-care advice.
• Let urine drain freely. Keep the bag below bladder level, tubing free of bends, and the catheter supported so it does not pull.
• Empty the bag regularly. Do so before it becomes full, usually around half to three-quarters full. Keep the outlet from touching the toilet or container.
• Follow the equipment plan. Avoid unnecessary disconnections. Use a valve only if your team has recommended one, and empty it on the schedule they give you.
• Drink appropriately and avoid constipation. Follow your usual hydration advice and any fluid restriction for heart or kidney disease. Fibre and regular bowel habits can help.

At night, follow the instructions for your larger drainage bag and keep it off the floor. Change bags, valves and catheters according to the product instructions and your clinical plan.

Sources: NHS: living with a catheter and Lancashire and South Cumbria NHS: catheter care.

When the catheter is not working as expected

Little or no urine in the bag

Check for kinked tubing, a full bag or tight straps, and make sure the bag is below your bladder. If drainage does not restart, contact your catheter team promptly or NHS 111. Do not wait if you have pain or feel unwell.

Do not try to clear a blockage by drinking large amounts, pushing the catheter in, or flushing it yourself. Flushing or changing it needs an appropriately trained person and a clinical plan.

Leakage, cramps or bleeding

Urine leaking around a catheter can occur with bladder spasms, constipation or blockage. It does not prove that the bladder is draining. Persistent leakage, painful spasms or blood in the urine need advice; heavy bleeding, clots or painful failure to drain need urgent assessment.

A catheter that falls out

Get urgent advice if an indwelling catheter comes out. If a suprapubic catheter falls out, seek help immediately from your catheter team or A&E because the opening can close quickly. Do not try to reinsert it unless specifically trained and instructed.

Sources: Lancashire and South Cumbria NHS: drainage problems, NHS: catheter risks and RNOH: catheter troubleshooting.

Does cloudy urine mean an infection?

Cloudiness or a strong smell alone does not establish a urine infection. Bacteria commonly live in the urine when a catheter has been in place for a while, without causing illness.

New fever, shivering, lower tummy or back pain, or feeling unwell needs prompt assessment. Antibiotics are not routinely needed for bacteria without symptoms. If testing is needed, staff should collect the sample correctly rather than from an old drainage bag.

Sources: NICE: catheter-associated urinary infection and NHS Scotland/SIGN: recognising infection with a catheter.

An option for greater independence

What is intermittent self-catheterisation?

Intermittent self-catheterisation, often shortened to ISC or CISC, means gently passing a small catheter into the bladder, allowing urine to drain, then removing it. For suitable people, it can provide an alternative to a catheter that stays in all the time.

It is understandable to feel nervous. A specialist nurse will choose suitable equipment, explain the technique and help you practise. A trained carer may assist if needed. Most catheters are single-use, with a new one for each catheterisation.

This article is an introduction, not an insertion guide. Start only after individual assessment and practical teaching. The method depends on your anatomy, catheter and medical history.

Source: BAUS: self-catheterisation in men.

How often will I need to do it?

Your nurse sets a schedule based on how much urine you pass yourself, how much remains and how much the catheter drains. You may be asked to keep a diary. There is no single schedule that suits everyone.

Follow the clean technique and product instructions you were taught. Avoid touching the part that enters the body. Do not skip prescribed catheterisations because you feel no urge, or reduce fluids simply to avoid doing them.

What if it becomes difficult?

Never force a catheter past resistance or pull hard if it will not come out. Stop and contact your nurse if there is pain, repeated difficulty or bleeding. If you cannot catheterise and cannot otherwise empty your bladder, seek urgent help, especially with fullness or pain.

Carry spare supplies when away from home and know who to contact out of hours. Review appointments help check that the routine is still right for you.

Further guidance: Gloucestershire Hospitals: ISC for adults and Royal Devon: self-catheterisation advice.

Treating prostate obstruction

Can Aquablation help with urinary retention?

When an enlarged prostate blocks the bladder outlet, treatment to open the passage may help you pass urine more easily. Aquablation is one option for selected patients with benign prostate obstruction. It is not a treatment for every cause of retention.

How does it work?

The surgeon uses ultrasound to map the prostate and plan treatment. A robot-assisted waterjet removes obstructing tissue through an instrument passed along the urethra. There is no external skin incision, and an anaesthetic is needed.

The waterjet removes tissue without heat, although electrical energy may be used to control bleeding. The aim is to create a wider channel for urine to flow.

Source: BAUS: Aquablation.

Will I be able to stop using a catheter?

That may be the aim, but it cannot be promised. Your urologist needs to assess both the obstruction and how strongly your bladder can squeeze. If the bladder muscle is weak, some people still need intermittent or longer-term catheter drainage after the blockage is treated.

Prostate size and shape, general health, blood-thinning medicines and your priorities all inform the decision. Alternatives may include medication, TURP, HoLEP or other procedures suitable for your anatomy. Ask which is most likely to help in your circumstances.

Sources: NICE: retention and impaired bladder function and Frimley Health: Aquablation and alternatives.

Catheters, recovery and possible risks

A catheter is used after Aquablation, sometimes with bladder irrigation in hospital. Removal is planned according to recovery. Some patients go home with it and return for a trial without catheter; a further period of drainage may be needed if emptying is not yet adequate.

Temporary burning, urgency and blood in the urine can occur. Risks include infection, bleeding requiring treatment, continued retention, scarring, leakage, changes to ejaculation or erections, and further treatment later. Preserving ejaculation is a consideration, but cannot be guaranteed.

Follow your discharge advice about activity and catheter care. Heavy bleeding, inability to pass urine or fever needs urgent help.

Sources: Frimley Health: recovery and complications and BAUS: Aquablation risks.

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Publisher: Birmingham Advanced Urology
Published: 18 September 2026

Suggested citation: Birmingham Advanced Urology. “Urinary retention: catheter care, self-catheterisation and Aquablation.” 18 September 2026.

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