From the Guidelines
Postoperative urinary retention in women is best managed through a stepwise approach beginning with conservative measures, with intermittent catheterization recommended if a woman cannot void within 6-8 hours after surgery or has a post-void residual volume greater than 200-300 mL, as indicated by 1.
Causes of Postoperative Urinary Retention
The causes of postoperative urinary retention in women include:
- Pelvic surgeries
- Neuraxial anesthesia
- Prolonged operations
- Excessive IV fluids
- Advanced age
- Pre-existing urinary issues These factors can contribute to the development of urinary retention, and identifying them is crucial for effective management, as noted in the context of urinary incontinence management 1.
Management of Postoperative Urinary Retention
Initial management includes:
- Ensuring adequate pain control
- Early mobilization
- Creating a comfortable, private voiding environment If these measures are insufficient, intermittent catheterization is recommended rather than indwelling catheters to reduce infection risk, as suggested by 1. Pharmacological options may include:
- Alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily), which relax the urethral sphincter, though these are used more cautiously in women than men
- Bethanechol (10-50 mg three times daily) may help by increasing bladder contractility
Prevention Strategies
Prevention strategies include:
- Limiting opioid use
- Avoiding anticholinergic medications
- Maintaining appropriate fluid balance
- Early removal of urinary catheters when used These strategies can help reduce the risk of postoperative urinary retention and promote a faster recovery, as implied by the principles of managing urinary incontinence 1.
Outcome and Further Management
Most cases of postoperative urinary retention resolve within 1-2 days with appropriate management. However, persistent retention requires urological consultation to rule out anatomical or neurological causes, emphasizing the importance of timely and effective management, as indicated by 1.
From the FDA Drug Label
Bethanechol Chloride Tablets, USP are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention.
The causes of postoperative urinary retention in women are not directly stated in the provided drug labels. The management of postoperative urinary retention in women may include the use of bethanechol chloride to stimulate the detrusor urinae muscle and initiate micturition, as it is indicated for the treatment of acute postoperative nonobstructive (functional) urinary retention 2.
From the Research
Causes of Postoperative Urinary Retention in Women
- Postoperative urinary retention (POUR) is a common complication of surgery, especially after urogynecologic surgery, with prevalence estimated between 2.5% and 24% 3
- The risk of POUR is increased following certain surgical procedures, such as surgical correction of urinary incontinence and pelvic organ prolapse, and with patients' advancing age 4, 5
- Other risk factors for POUR include the type of anesthesia used and the patient's overall health status 5
Management of Postoperative Urinary Retention in Women
- The key to management of POUR is early identification, and all patients undergoing pelvic surgery should have an assessment of voiding function prior to discharge 4
- Management of POUR is fairly straightforward, with the goal of decompressing the bladder to avoid long-term damage to bladder integrity and function 4
- Techniques for managing POUR include:
- Catheterization, either intermittent or indwelling 6, 7
- Urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis for patients who do not respond to conservative management 4
- Pharmacological treatment, such as cholinergic agents and alpha-blockers, although the evidence for these treatments is weak 6
- Intermittent self-catheterization (ISC) is generally considered preferable to indwelling catheterization wherever possible, as it reduces the risk of catheter-associated urinary tract infections 3, 7