From the Guidelines
Urinary retention is not a typical direct complication of an orchiectomy, as the procedure does not directly involve the urinary tract structures. The most common complications of orchiectomy include bleeding, infection, pain, swelling, and changes in hormone levels if both testicles are removed [@\1@]. Urinary problems are rare following this procedure because the surgery focuses on the scrotum and testicles, which are separate from the urinary system. However, temporary urinary issues might occur due to general anesthesia effects, pain medications, or if a urinary catheter was used during surgery.
Some key points to consider:
- The use of urinary catheters during surgery can increase the risk of urinary tract infections, and their removal should be considered as soon as possible [@\2@].
- Patients with pre-existing conditions such as prostate enlargement or urethral stricture may be at higher risk for urinary retention [@\2@].
- The management of acute urinary retention is crucial, and treatment is recommended if asymptomatic or symptomatic with a postvoid residual bladder volume > 500 cm3 or > 300 cm3, respectively [@\1@].
In the context of an orchiectomy, it is essential to assess the patient's risk for urinary retention preoperatively and to remove any urinary catheter as soon as possible to minimize the risk of complications [@\2@]. If difficulty urinating persists after an orchiectomy, it's likely unrelated to the procedure itself and could indicate another condition such as prostate enlargement, urethral stricture, or medication side effects. Any persistent urinary problems following surgery should be reported to a healthcare provider for proper evaluation and treatment.
From the Research
Urinary Retention as a Complication of Orchiectomy
- Urinary retention is a potential complication of various surgical procedures, including urologic surgery 1, 2, 3.
- The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age 3.
- Orchiectomy, or the surgical removal of one or both testicles, is a type of urologic surgery that may carry a risk of post-operative urinary retention.
Studies on Post-Operative Urinary Retention
- A study published in 2010 found that post-operative urinary retention can lead to several complications, including urinary tract infection, long-term bladder dysfunction, and kidney damage 1.
- Another study published in 2016 found that the use of prophylactic alpha-blockers, such as tamsulosin and alfuzosin, can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia 2.
- A review article published in 2013 provided an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options, highlighting the importance of identifying at-risk patients and providing timely treatment 3.
Management and Prevention of Urinary Retention
- Drug-induced urinary retention is a condition in which impaired emptying of the bladder results in post-voidal residual urine, and can be caused by various medications, including those with anticholinergic activity, opioids, and anaesthetics 4.
- Alpha-blockers, such as alfuzosin, have been shown to effectively reduce the symptoms associated with benign prostatic hyperplasia and improve the urodynamic parameters of obstruction, and may diminish the incidence of acute urinary retention and the need for surgical intervention 5.
- The management of post-operative urinary retention typically involves catheterization, and preventive measures, such as the use of alpha-blockers, may be effective in reducing the incidence of urinary retention after urologic surgical procedures 2, 5.