From the Guidelines
Postoperative urinary retention is most commonly caused by factors such as male sex, pre-existing prostatism, open surgery, neoadjuvant therapy, large pelvic tumors, and abdominal perineal resection (APR) 1. The causes of postoperative urinary retention can be multifactorial, and it is essential to assess the patient's risk preoperatively.
Risk Factors
- Male sex
- Pre-existing prostatism
- Open surgery
- Neoadjuvant therapy
- Large pelvic tumors
- Abdominal perineal resection (APR) According to a recent study, urinary retention is uncommon, occurring in only 14% of patients in an enhanced recovery after surgery (ERAS) program 1.
Prevention Strategies
- Limiting opioid use
- Early ambulation after surgery
- Adequate pain control
- Avoiding anticholinergic medications when possible It is crucial to weigh the benefits of urinary catheterization against the risks, including urinary tract infections, which are the most common hospital-acquired infection 1.
Management
- Bladder catheterization, either with an indwelling Foley catheter or intermittent straight catheterization, is typically the first line of management for postoperative urinary retention.
- For patients with retention after catheter removal, a trial of voiding should be attempted after 24-48 hours.
- If retention persists, alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily) can be effective, particularly in men with prostatic enlargement 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Postoperative Urinary Retention
The causes of postoperative urinary retention are multifactorial and can be attributed to various factors, including:
- Comorbidities, such as advanced age, which increases the risk of retention 2
- Type of surgery, with certain procedures like anorectal surgery, hernia repair, and orthopedic surgery 2 and urogynecologic surgery 3 being more prone to postoperative urinary retention
- Anesthesia, with spinal anesthesia with long-acting local anesthetics and epidural analgesia promoting the development of urinary retention 2
- Analgesic modalities, which can also contribute to the development of postoperative urinary retention 2
Risk Factors
Several risk factors can contribute to the development of postoperative urinary retention, including:
- Pre-operative risk factors, which can be modified to prevent postoperative urinary retention 4
- Clinical risk factors, such as the type of surgery and anesthesia used 3, 4
- Patient-related factors, such as age and comorbidities 2
Incidence and Diagnosis
The incidence of postoperative urinary retention varies between 5% and 70% 4 and can be diagnosed using various methods, including: