Already in Urinary Retention?

If you’re reading this with a catheter (a thin, flexible tube that drains urine from the bladder) in place — or you just had your first episode of being unable to urinate — you’ve landed on the right page. Read the four sections below. Then call.

What’s happening

Acute urinary retention (being unable to empty the bladder on your own) happens when the obstruction from an enlarged prostate becomes severe enough that the bladder can no longer push urine through. The result is either an acute episode (sudden inability to urinate, requiring an emergency-room visit and catheter placement) or chronic retention (a catheter in place day-to-day because spontaneous urination has stopped working).

This is one of the most common emergency-room presentations in older men, and it is also one of the most underserved by routine urology care. Many men in retention are told to “wait and see if it resolves,” continued on medication, and given another catheter when the next episode happens — without ever being clearly offered the surgical option that would resolve the underlying problem.

You are very likely a HoLEP candidate.

Why this is HoLEP territory specifically

Men in retention tend to have one or more of the following: a very large prostate, a bladder that has been working against obstruction for a long time, a history of trial-without-catheter failures, comorbidities (other ongoing medical conditions) that have made other surgeons reluctant.

These are precisely the patients HoLEP serves well:

Very large prostates — HoLEP has the highest published size range of any benign prostatic hyperplasia (BPH) procedure (30 grams to 300+ grams, with randomized-trial evidence above 100 g). Many men in retention have prostates above the upper size limits of UroLift, Rezum, GreenLight photoselective vaporization (PVP), and iTind.
Failed trial-without-catheter — men who have failed multiple TWOC attempts on medication often pass the trial after HoLEP because the obstruction is mechanically resolved, not pharmacologically masked.
Comorbidities — HoLEP’s bleeding profile is favorable. Patients with cardiac disease, on anticoagulation (blood-thinning medication), with renal insufficiency, or with significant pulmonary disease are often HoLEP candidates even when they have been told they are not surgical candidates elsewhere.
Older age — published outcomes are excellent in men over 80; recent series specifically demonstrate safety and effectiveness in men over 85.

If you have been told you are not a surgical candidate because of prostate size, comorbidity, age, or anticoagulation — a HoLEP-experienced center is the appropriate place for a second opinion.

What to expect

The realistic pathway from a first visit in retention to definitive surgery:

Consultation with Dr. Quarrier. Review of history, current symptoms, current medications, comorbidities. Discussion of HoLEP and what to expect.
Pre-operative work-up — imaging (typically transrectal ultrasound (TRUS) or MRI for prostate volume), basic labs, anesthesia evaluation. For men on anticoagulation, individualized medication management.
Surgery at Strong Memorial Hospital or Highland Hospital. Most HoLEP cases are 1–2 hours, and most patients go home the same day with the catheter in place.
Catheter removal at home — typically 24–48 hours after surgery, following instructions given before discharge. Most men who were in retention before surgery urinate well as soon as the catheter is out — the obstruction is gone.
Follow-up — a phone touch point at about 2 weeks to confirm you’re progressing well and review pathology, then an in-person visit at about 3 months. Symptom relief is durable; retreatment rates at 5 and 7 years are near zero.

What to do now

If you are currently in retention with a catheter in place, or you have had one or more episodes of acute retention, call UR Medicine Urology to schedule a consultation with Dr. Quarrier:

(585) 275-2838

Tell the scheduling staff:

That you are in urinary retention (or have a history of acute retention episodes).
That you have a catheter in place (if applicable).
That you are seeking a HoLEP consultation specifically.

The clinic is at 158 Sawgrass Drive in Rochester. Dr. Quarrier operates at both Strong Memorial Hospital and Highland Hospital.

If you do not have a catheter in place but you are unable to urinate right now, this is a medical emergency. Go to the nearest emergency room. The HoLEP consultation comes after the immediate catheter placement.