From the Guidelines
Diabetic patients are indeed predisposed to postoperative urinary retention due to several factors related to their condition, and healthcare providers should prioritize preventive measures to minimize this risk. Diabetic autonomic neuropathy affects bladder function by impairing detrusor muscle contractility and reducing bladder sensation, making it difficult for patients to sense bladder fullness and effectively empty their bladder after surgery 1. This risk is further increased by the use of anesthetic agents, opioid analgesics, and anticholinergic medications commonly administered during the perioperative period.
To manage this risk, healthcare providers should implement preventive measures including:
- Optimizing glycemic control before surgery (maintaining blood glucose between 140-180 mg/dL)
- Limiting opioid use when possible
- Considering alternative pain management strategies such as NSAIDs or regional anesthesia
- Ensuring adequate hydration
- Early ambulation after surgery should be encouraged when appropriate For high-risk diabetic patients, intermittent catheterization may be preferable to indwelling catheters to reduce infection risk, with a schedule of every 4-6 hours initially, adjusting based on output volumes 1. If pharmacological intervention becomes necessary, bethanechol (10-50 mg orally three to four times daily) or tamsulosin (0.4 mg daily) may be considered to improve bladder emptying.
The most recent and highest quality study 1 suggests that urinary catheterization should be used judiciously and removed as early as possible to minimize the risk of urinary tract infections. The study recommends that urinary catheters be removed on postoperative day 1, even in patients with epidural analgesia, to reduce the risk of urinary tract infections and promote early mobilization. Healthcare providers should prioritize the use of intermittent catheterization and early removal of urinary catheters to minimize the risk of postoperative urinary retention and urinary tract infections in diabetic patients.
From the Research
Diabetics and Postoperative Urinary Retention
- Diabetics may be at risk for postoperative urinary retention due to various factors, including the type of surgery, anesthesia, and comorbidities 2.
- A study found that diabetic patients had a similar rate of urinary retention requiring clean intermittent catheterization after intravesical onabotulinumtoxinA injection for overactive bladder compared to nondiabetic patients 3.
- However, diabetic patients had an increased risk of urinary tract infection based on disease severity 3.
Risk Factors for Postoperative Urinary Retention
- Spinal anesthesia, longer surgery time, and older age are independent risk factors for urinary retention catheterization 4.
- Other risk factors include a maximum bladder capacity < 500 mL, duration of surgery ≥ 60 min, first scanned bladder volume at the Post Anesthesia Care Unit ≥250mL, and age ≥ 60 years 4.
- Diabetes mellitus may also be a risk factor for postoperative urinary retention, particularly in older adults 5.
Management and Complications
- Urinary catheterization may be necessary to manage postoperative urinary retention, but inappropriate management can lead to bladder overdistension, urinary tract infection, and catheter-related complications 2.
- A study found that a urinary catheter inserted during hospitalization but not removed was associated with 1-year mortality in diabetic older adults with urinary retention 5.
- Tamsulosin, an alpha(1)-adrenoceptor antagonist, may be effective in managing lower urinary tract symptoms, including urinary retention, in patients with benign prostatic hyperplasia, including those with diabetes mellitus 6.