Treatment of postoperative urinary retention

Postoperative urinary retention is quite frequent in elderly patients. Especially after abdominal and orthopedic surgeries. It has a prevalence between 12% and 50%, depending on the characteristics of each patient, the type of surgery and anesthesia.

The most common risk factors are immobility, pain, drugs, advanced age and male gender. However, in all cases, the urological background must be considered.

Causes of postoperative urinary retention

Urinary retention It is a usual postoperative complication. It is observed with a high frequency in patients who undergo perianal and hernia repair interventions. The causes of postoperative urinary retention can be diverse and include:

• Obstruction of the lower urinary tract: caused by immobility, fecal impaction or surgery.
• Bladder hypocontractility: related to the drugs used.
• Pelvic parasympathetic nerve injury: in some types of pelvic surgery.

It is advisable to try to avoid the placement of a permanent bladder catheter. For it recourse to programmed urination and bladder reeducation.

Also, during hospitalization, urinary retention may occur. Especially if it's frail elderly or that present pelvic functional deterioration.

What are the associated symptoms?

When there is postoperative urinary retention, there is urgency and pain in the area. The suprapubic percussion reveals the existence of fullness and sensitivity. In addition, there may be symptoms such as:

• Inability to urinate.
• Suprapubic pain and restlessness.
• Abdominal distension.
• Full bladder and need to urinate.
• Chills, tremors, sweat and headache.

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Diagnosis

For the diagnostic, a physical examination is done. Discomfort and pain in the lower abdomen may indicate postoperative urinary retention. Palpation and percussion of the suprapubic area is another method used for diagnosis although it is not very sensitive when measuring residual urinary volume.

On the other hand, Bladder catheterization is used for both diagnosis and treatment. While the use of ultrasound allows to measure the volume contained in the bladder in a very exact way. For this reason, if the volume is greater than 600 ml, probing is indicated.

On what is the treatment based?

But nevertheless, in most cases postoperative urinary retention is a reversible anomaly. It appears due to an incoordination of the trigone and detrusor muscles as a consequence of postoperative pain and discomfort.

Generally, the problem is addressed through the use of a probe. The general principles of the treatment of acute urinary retention consist in the initial placement of a straight probe or a Foley catheter. Especially in elderly patients and those who have undergone an anterior resection, as they may be unable to perceive the sensation of fullness that causes retention.

The use of cholinergic drugs, combined with a sedative can help. In order to prevent acute retention, it is essential to know the time elapsed since the last urination until the present moment. Most patients should not be more than 6 or 7 hours without urinating.

Read also: 6 exercises to prevent urinary incontinence

Risk factors of postoperative urinary retention

These are some risk factors that favor urinary retention after having undergone an operation. It does not mean that if the patient presents any of them he will suffer from the disease, only increase the chances of suffering.

• Age and sex: in patients older than 50 years it is more frequent.
• Type of surgery: The incidence of postoperative urinary retention is less than 4%. Although it can reach more than 80% in processes such as hip arthroplasty.
• Comorbidities: especially neurological diseases such as stroke, poliomyelitis, multiple sclerosis, spinal injuries as well as diabetic and alcoholic neuropathy.
• Drugs: numerous drugs used in the perioperative period can interfere with bladder function. Anticholinergic agents such as atropine block the contractions of the detrusor muscle of the bladder necessary for urination. For this reason, they can cause bladder hypotonia and postoperative urinary retention.
• Intravenous fluids: the amount of intravenous fluids can influence the development of the condition. In fact, in certain surgeries such as anorectal if more than 750 ml are administered, it could increase the risk of postoperative urinary retention.