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Introduction Acute urinary retention (AUR) is a common urological presentation to emergency departments (ED). An ambulatory care protocol had been developed allowing trial without catheterization (TWOC) instead of admission to hospital after catheterization in the ED. This study aimed to evaluate the efficacy of the ambulatory care protocol for patients with AUR. The secondary aim was to identify any independent predictor(s) for successful weaning of urinary catheter in a short duration. Methods This was a prospective cohort study. A total of 143 male patients presenting with an episode of AUR underwent urinary catheterization once. Those who were unable to pass urine afterwards were catheterized again and discharged home with a urinary catheter in-situ (Day 0). On Day 3, ability of spontaneous urination was assessed. If failed, spontaneous urination was assessed again on Day 6. Results Successful TWOC was recorded in 50.3% of the 143 patients after first catheterization. The cumulative successful rates for first (Day 3) and second (Day 6) follow-ups were 76.9% and 79.0%, respectively. Among the associated predictors, only the urine retention volume on first catheterization was found to be independently associated with successful TWOC, using binary logistic regression (p=0.001). Conclusion The ambulatory care protocol was successful in weaning off urinary catheter for 50.3% of patients with AUR after first catheterization and a further 26.6% on Day 3, making a cumulative success rate of 76.9%. Those who failed TWOC on Day 3 would get little benefit on further trials. The first catheterization volume was independently associated with the chance of successful TWOC.

Lau Fei Lung, FRCP(Edin), FHKCEM, FHKAM(Emergency Medicine)We report a 29-year-old lady who developed confusion, agitation and seizure after the ingestion of a selfmixture of 3 grams of lidocaine with antacid for treatment of dyspepsia. She developed two episodes of seizure requiring diazepam, propofol and intubation .There was no significant cardiac toxicity and she was discharged on day 3. This is the first reported adult case of seizure in the literature after intentional ingestion of lidocaine for treatment of dyspepsia. The use of local anaesthetic in gastrointestinal cocktail for dyspepsia and its safety are highlighted. Advances in the management of local anaesthetic overdose are also discussed. (Hong Kong j.emerg.med. 2009;16:41-45) 29 3

Bladder scan was firstly used in the ambulatory management protocol for acute urinary retention (AUR) in Princess Margaret Hospital (PMH) emergency department (ED) since 2012. Bladder scan measurement was performed immediately after triage for early catheterisation in the new protocol for AUR. The primary objective of this study was to evaluate the accuracy of bladder scan in estimating the volume of urinary retention. The secondary objectives were to evaluate the change in unnecessary catheterisation rate and the change in door to catheterisation time (DTCT) after the implementation of new protocol. Setting: Emergency department of a regional hospital. Methods: Male patients over 40 years old presenting to the ED of PMH for difficulty to void within the study period were enrolled and managed according to the study protocol. Agreement analysis was carried out by the Bland and Altman method. The changes in DTCT were assessed by comparing data of current study and historical control. Results: A total of 121 male patients were recruited. The bias between bladder scan readings and catheterised volume was 26.09 ml when the average bladder scan measurement and catheterised volume was 300ml. The 95% upper and lower limit were-95.82 ml and 151 ml, respectively. The relative risk reduction of unnecessary catheterisation was 90.9%. The absolute risk reduction was 8.26%. Number need to treat was 12 (95% CI 8-30). The DTCT of current study were shorter than that of historical control (DTCT: 22.85 minutes vs. 48.42 minutes; p<0.001). Conclusions: Agreement between bladder scan readings and catheterised volume is satisfactory. Bladder scan can serve as a device to facilitate nurses to make decision on early catheterisation for AUR patients with presumed diagnosis of benign prostatic hypertrophy. (Hong Kong j.emerg.med. 2014;21:300-307) 目的： 2 01 2 年以來，瑪嘉烈醫院急診科(ED)首次在急性尿瀦留(AUR)病人應用膀胱掃描非住 院治理方案。在新方案，病人分流後立即進行膀胱掃描測量，以便安排早期插管導尿。本研究的主要目 的是評估膀胱掃描在估計尿瀦留量的準確度。次要目的是評估新的方案實施後，不必要的導尿率及到診 至導尿時間(DTCT)的變化。場所：某區域醫院急診科。方法：在研究期間，招收 40 歲以上因排尿 困難到診瑪嘉烈醫院的男患者，並根據研究方案治理。用布蘭德和奧特曼方法分析同意度。通過對照目 前的研究及歷史數據，評估 DTCT 的變化。結果：共招募了 121 例男性患者。當膀胱掃描測量和導尿量 平均為 300 毫升，膀胱掃描讀數和導尿量之間的偏差為 26.