From the Guidelines
The initial management step for a female patient with urinary retention requiring catheterization is to perform intermittent catheterization for initial management. This approach is supported by the most recent and highest quality study, which recommends intermittent catheterization as the initial management for urinary retention 1. The procedure should begin with explaining the process to the patient and obtaining consent, followed by positioning the patient in the dorsal lithotomy position to ensure proper lighting and visualization of the urethral meatus. Key considerations include:
- Using an aseptic technique, including sterile gloves, drapes, and cleansing the perineal area with antiseptic solution
- Gently inserting the lubricated catheter through the urethral meatus until urine flow is established
- The choice of catheter material and method, such as hydrophilic, gel reservoir, or non-coated catheters, may vary depending on the patient's specific needs and preferences, as discussed in previous studies 1 However, the most recent guideline prioritizes intermittent catheterization as the initial step, without specifying the type of catheter 1. It's also important to note that concomitant administration of an alpha-blocker may be considered in certain cases, such as in patients with benign prostatic hyperplasia, but this is not directly applicable to the initial management of urinary retention in female patients 1. Overall, the focus should be on providing a safe and effective initial management approach for urinary retention, with intermittent catheterization being the recommended first step.
From the Research
Initial Management of Urinary Retention in Females
The initial management step for a female patient with urinary retention requiring catheterization involves:
- Assessment of urethral patency with prompt and complete bladder decompression by catheterization 2, 3
- Bladder catheterization is the initial management step to relieve urinary retention 2
- The choice of catheterization method (urethral or suprapubic) depends on the individual case, with suprapubic catheterization potentially offering advantages in terms of patient comfort and reduced risk of infection 2, 3
Considerations for Catheterization
- The use of silver alloy-impregnated or antibiotic-impregnated catheters may help reduce the risk of urinary tract infection, although the evidence for this is not conclusive 2, 3
- Clean intermittent self-catheterization can be an effective management strategy for patients with chronic urinary retention, particularly those with neurogenic bladder 4, 5
- The risk of urinary tract infection is a significant consideration in the management of urinary retention, and strategies to prevent infection should be implemented wherever possible 4, 6, 5