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Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalisation, catheterisation and often surgery (Kirby, 1998). AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. The management of AUR is highly dependent on the cause, mainly BPH and clot/haematuria. Medical management will often necessitate the insertion of a urinary catheter, a procedure which is associated with an increased risk of urinary tract infections (Mulhall et al, 1998). The use of alpha-adrenegic antagonists (alpha-blockers), 5-alpha-reductase inhibitors, a trial without catheter and the catheter valve are recommended to delay or prevent the need for surgery and future complications. Proper assessment and documentation, particularly in relation to the catheterisation process is of vital importance. The authors demonstrate how audit was used in the development of a management pathway to provide guidance to accident and emergency (A&E) practitioners in their delivery of care to patients who presented to the A&E with AUR.