From the Guidelines
Post-catheterization urinary retention, also known as Post-Renal Catheterization Urinary Retention, is primarily caused by catheter-associated factors and can be treated with intermittent catheterization.
Causes of Post-Catheterization Urinary Retention
- Catheter-associated urinary tract infections are a major cause of post-catheterization urinary retention, with the risk increasing with the duration of catheterization 1.
- Pre-existing conditions, such as prostatism, open surgery, neoadjuvant therapy, large pelvic tumors, and abdominal perineal resection (APR), can also contribute to the risk of urinary retention 1.
- Epidural analgesia may also increase the risk of urinary retention, although this risk is low after 24 hours of urinary bladder catheterization 1.
Treatments for Post-Catheterization Urinary Retention
- Intermittent catheterization is a recommended treatment for urinary retention, particularly for initial management 1.
- Early removal of the urinary catheter, ideally within 24 hours, can reduce the risk of urinary tract infections and promote faster recovery 1.
- Suprapubic bladder catheterization may be associated with lower rates of bacteriuria and lower patient discomfort than transurethral drainage, although its benefit in short-term transurethral drainage is uncertain 1.
- Hydrophilic, gel reservoir, and non-coated catheters are available for intermittent self-catheterization, although the most clinically effective and cost-effective approach remains uncertain 1.
From the Research
Causes of Post-Catheterization Urinary Retention
- Urinary retention can be caused by a wide range of intrinsic and extrinsic, obstructive and non-obstructive factors affecting the lower urinary tract 2
- Drug-induced urinary retention is a common cause, with medications such as anticholinergic agents, opioids, and alpha-adrenoceptor agonists contributing to the condition 3
- Postoperative urinary retention is a common complication of surgery and anesthesia, particularly after anorectal surgery, hernia repair, and orthopedic surgery 4
Treatments for Post-Catheterization Urinary Retention
- Proper bladder drainage with urethral or suprapubic catheter is the first line of treatment for acute urinary retention 2
- Clean intermittent catheterization has been shown to be effective in managing urinary retention after gynecological surgery, with a lower incidence of urinary tract infections compared to transurethral indwelling catheterization 5
- Catheterization is recommended when bladder volume exceeds 600 mL to prevent the negative sequelae of prolonged bladder overdistention 4
- Management of urinary retention also consists of a variety of options depending on the cause of retention, including conservative treatment, drug therapy, and several forms of surgery 2
Risk Factors for Post-Catheterization Urinary Retention
- Elderly patients are at higher risk for developing drug-induced urinary retention due to existing co-morbidities and the use of other concomitant medication 3
- Advancing age increases the risk of postoperative urinary retention 4
- Certain anesthetic and analgesic modalities, particularly spinal anesthesia with long-acting local anesthetics and epidural analgesia, promote the development of urinary retention 4