From the Guidelines
Management of postoperative urinary retention requires immediate bladder catheterization to relieve distention, and the catheter should be left in place for 24-48 hours to allow bladder muscle recovery, as recommended by the most recent guidelines 1. The patient's symptoms of urinary retention and "dribbling" after surgery to repair a right inguinal hernia, along with a bladder scan result of 1200 cc, indicate the need for prompt intervention to prevent further complications.
- The insertion of a 16 Fr Foley catheter with immediate return of clear yellow urine and significant relief reported by the patient suggests that this approach is effective in managing postoperative urinary retention.
- According to the guidelines, early removal of the urinary catheter is recommended to reduce the risk of catheter-associated urinary tract infection (CAUTI) and promote patient mobility and comfort 1, 2.
- However, the decision to remove the catheter should be based on individual patient factors, such as the need for strict fluid management, patient immobility, or epidural analgesia 1.
- In general, patients with low risk of postoperative urinary retention may have their transurethral bladder catheter removed on postoperative day 1, even if epidural analgesia is used 3.
- It is essential to assess the patient's risk factors for urinary retention preoperatively and to consider the use of alpha-blockers or other pharmacological interventions to facilitate urination, if necessary.
- Adequate pain management and proper fluid management are also crucial in preventing and managing postoperative urinary retention, and early mobilization should be encouraged to promote normal bladder function.
From the Research
Management of Postoperative Urinary Retention
The patient's symptoms of urinary retention and "dribbling" after surgery to repair a right inguinal hernia are consistent with postoperative urinary retention (POUR). The management of POUR typically involves the insertion of a urinary catheter to relieve the obstruction and mitigate the underlying cause of retention 4.
Causes and Risk Factors
The etiology of urinary retention can be varied and multifactorial, including benign prostatic hyperplasia (BPH), clot/haematuria, and postoperative complications 5, 4. The incidence of POUR increases with age and is a common problem encountered in the emergency department 4.
Treatment and Evaluation
Treatment of POUR aims to relieve the obstruction and mitigate the underlying cause of retention. This can generally be accomplished in the emergency department without immediate urologic consultation; however, certain clinical features may require specialist involvement 4. 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 5.
Catheter Management
The insertion of a urinary catheter is a common management strategy for POUR. However, indwelling catheters have been associated with a substantial risk of urinary tract infection (UTI) 6. Early catheter removal after surgery may help reduce the risk of UTI 6. The culture of a catheter tip specimen should be discouraged for the diagnosis of UTI within the first 24 hours after surgery 6.
Prediction and Prevention
Voiding efficiency is an effective indicator of postoperative urinary retention in urological and gynaecological fields, and may also be useful in predicting POUR in colorectal surgery patients 7. The use of a modified Foley catheter and drainage system with oligodynamic bactericidal properties may help prevent urinary tract infections owing to prolonged bladder catheterization 8.
- Key points to consider in managing postoperative urinary retention: + Insertion of a urinary catheter to relieve obstruction and mitigate underlying cause of retention + Use of alpha-adrenegic antagonists, 5-alpha-reductase inhibitors, and catheter valve to delay or prevent surgery and future complications + Early catheter removal after surgery to reduce risk of UTI + Voiding efficiency as a predictor of postoperative urinary retention + Use of modified Foley catheter and drainage system to prevent urinary tract infections