From the Guidelines
Managing Urinary Retention after VATS
For a patient retaining urine after a VATS procedure, adequate pain management is crucial as pain can exacerbate urinary retention 1. Administering a non-steroidal anti-inflammatory drug (NSAID) like ketorolac 15-30 mg IV every 6 hours as needed, or an opioid like morphine 2-4 mg IV every 2-4 hours as needed, may help. However, it's essential to consider the potential side effects of these medications, including the risk of urinary retention associated with opioids 1.
Catheterization and Alpha-Blockers
Next, consider catheterization to relieve the retention. If the patient is unable to void after catheter removal, a trial of an alpha-blocker such as tamsulosin 0.4 mg orally once daily for 24-48 hours may be beneficial to help relax the bladder neck and facilitate voiding 1. The use of alpha-blockers is supported by expert opinion and may increase the success of a voiding trial, especially if the underlying retention is precipitated by temporary factors like anesthesia.
Additional Measures
Additionally, ensuring the patient is well-hydrated and mobilizing them as soon as possible can also aid in resolving urinary retention. Early mobilization is crucial for preventing complications and promoting recovery after surgery. If urinary retention persists, further evaluation by a urologist may be necessary to rule out other underlying causes.
Considerations
It's also important to note that certain analgesic interventions, such as thoracic epidural, are not recommended for pain management in patients undergoing VATS due to the risk of urinary retention and other side effects 1. Instead, less invasive techniques like paravertebral block or ESP block may be considered for pain management. By prioritizing pain management, catheterization, and the use of alpha-blockers, and by considering the potential risks and benefits of different analgesic interventions, healthcare providers can effectively manage urinary retention after VATS procedures.
From the FDA Drug Label
The most frequently observed adverse reactions include ... constipation, and diaphoresis... Genitourinary – Oliguria and urinary retention; an antidiuretic effect has been reported. The patient experiencing urinary retention after a Video-Assisted Thoracic Surgery (VATS) procedure may be experiencing an adverse reaction to a medication such as morphine 2.
- Key considerations:
- Review the patient's medication list to identify potential causes of urinary retention.
- Consider alternative pain management options that do not cause urinary retention.
- Monitor the patient's urinary output and overall clinical status closely. Note that tamsulosin 3 is used to treat urinary retention caused by benign prostatic hyperplasia (BPH), but there is no information in the provided drug label that directly supports its use in this specific scenario.
From the Research
Management of Urinary Retention after VATS
There is limited information available on the management of urinary retention after Video-Assisted Thoracic Surgery (VATS) in the provided studies. However, some general information on VATS procedures and their complications can be found:
- The studies primarily focus on the safety, efficacy, and techniques of VATS procedures, including the use of local anesthesia and sedation 4, 5, 6.
- Complications associated with VATS procedures are discussed in one study, but urinary retention is not specifically mentioned 7.
- None of the studies provide direct guidance on managing urinary retention after VATS.
Potential Considerations
While the provided studies do not directly address urinary retention after VATS, some potential considerations can be inferred:
- The use of local anesthesia and sedation during VATS may reduce the risk of certain complications, but its impact on urinary retention is unclear 4, 5, 6.
- The overall safety and efficacy of VATS procedures suggest that urinary retention may be a relatively rare complication, but this is speculative and requires further research.
- As with any surgical procedure, careful monitoring and management of postoperative complications, including urinary retention, are essential to ensure optimal patient outcomes.
Available Information
Unfortunately, there is no specific information available in the provided studies to directly answer the question of how to manage urinary retention after VATS. Further research or consultation with medical professionals may be necessary to address this topic.