Management of Bladder Function after Outpatient Surgery

Background: This study was designed to test a treatment algorithm for management of bladder function after outpatient general or local anesthesia.

Methods: Three hundred twenty-four outpatients, stratified into risk categories for urinary retention, were studied. Patients in category 1 were low-risk patients (n = 227) having non-pelvic surgery and randomly assigned to receive 10 ml/kg or 2 ml/kg of intravenous fluid intraoperatively. They were discharged when otherwise ready, without being required to void. Patients in category 2 (n = 40), also presumed to be low risk, had gynecologic surgery. High-risk patients included 31 patients having hernia or anal surgery (category 3), and 31 patients with a history of retention (category 4). Bladder volumes were monitored by ultrasound in those in categories 2-4, and patients were required to void (or be catheterized) before discharge. The incidence of retention and urinary tract symptoms after surgery were determined for all categories.

Results: Urinary retention affected 0.5% of category 1 patients and none of category 2 patients. Median time to void after discharge was 75 min (interquartile range 120) in category 1 patients (n = 27) discharged without voiding. Fluids administered did not alter incidence of retention or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after discharge.     

Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery.

The goal of this study was to determine whether recovery room monitoring of bladder volume would affect patient outcome after ambulatory surgery. Incidence of urinary retention and times to void and to discharge were compared in 161 patients managed with ultrasound bladder monitoring versus 173 controls without bladder monitoring. Urinary retention was diagnosed by clinical means or by ultrasound, confirmed by bladder catheterization. Patients were required to void or were catheterized before discharge. In the control patients without underlying risk factors for retention, median time to void was 95 min, and retention occurred in 0.8%, which was not significantly different from the ultrasound group (80 min and 0%, respectively). After hernia/anal surgery or spinal/epidural anesthesia, voiding was delayed (130 and 213 min), incidence of retention was increased (17% and 13%), and there was a trend toward earlier voiding (168+/-99 vs. 138+/-68 min) with bladder monitoring. We conclude that most patients at low risk of retention void within 3 h of outpatient surgery; their outcome is unaffected by bladder monitoring. After hernia/anal surgery and spinal/ epidural anesthesia, the likelihood of urinary retention is increased, and ultrasound monitoring facilitates deciding whether such patients should be catheterized. IMPLICATIONS: Incidence of bladder catheterization and urinary retention were compared in patients managed with and without ultrasound monitoring of bladder volume after outpatient surgery. Monitoring did not alter outcome in patients at low risk of retention, but it facilitated determining when to catheterize patients at high risk of retention (hernia/anal surgery, spinal/epidural anesthesia).     

Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia

BACKGROUND: Voiding before discharge is usually required after outpatient epidural or spinal anesthesia because of concern about bladder overdistention and dysfunction. Shorter duration spinal and epidural anesthesia may allow return of bladder function before overdistention occurs in low-risk patients (those younger than age 70, not having hernia, rectal, or urologic surgery, and without a history of voiding difficulty), and predischarge voiding may not be necessary. METHODS: After institutional review board approval and informed consent, 201 low-risk ambulatory patients were prospectively studied in either a standard or accelerated pathway after undergoing spinal or epidural anesthesia with procaine, lidocaine, 2-chloroprocaine, or less than 7 mg bupivacaine; epinephrine was not used in any anesthetic. Standard pathway patients (n = 70) were required to void before discharge. Accelerated pathway (n = 131) patients were not required to void. (After randomization of an initial 163 patients to one of the two tracks, 38 additional patients were assigned to the accelerated pathway.) If accelerated pathway patients voided, they were discharged when all other discharge criteria were met. If they did not spontaneously void after block resolution, a bladder ultrasound (BUS) was performed. If the BUS indicated a urine volume of less than 400 ml, the patients were discharged and instructed to return to the emergency department if they were unable to void within 8 h of discharge. If the BUS indicated a urine volume of greater than 400 ml, the patients were reassessed in 1 h and were discharged if they could void spontaneously. If they could not void spontaneously, they were catheterized to facilitate discharge. All patients were contacted the next day to assess the return of normal bladder function. RESULTS: All standard pathway patients voided without difficulty, and were discharged in 153 +/- 49 (SD) min. 62 patients in the accelerated pathway voided spontaneously after resolution of their block and were discharged in 127 +/- 41 min. 46 patients were discharged with a BUS less than 400 ml in 120 +/- 42 min. 23 patients had a BUS greater than 400 ml: of these, 20 patients voided within an hour and were discharged in 162 +/- 45 min. Three were catheterized after 1 h, and were discharged in 186 +/- 61 min. Mean discharge time for all patients in the accelerated pathway was 22 min shorter than the standard pathway (P = 0.002). No patients had difficulty voiding or returned to the hospital for urinary problems. None reported new urologic symptoms. CONCLUSIONS: Delay of discharge after outpatient spinal or epidural anesthesia with short-duration drugs for low-risk procedures is not necessary, and may result in prolonged discharge times.     

Ambulatory Surgery Patients May Be Discharged before Voiding after Short-acting Spinal and Epidural Anesthesia

Background: Voiding before discharge is usually required after outpatient epidural or spinal anesthesia because of concern about bladder overdistention and dysfunction. Shorter duration spinal and epidural anesthesia may allow return of bladder function before overdistention occurs in low-risk patients (those younger than age 70, not having hernia, rectal, or urologic surgery, and without a history of voiding difficulty), and predischarge voiding may not be necessary.

Methods: After institutional review board approval and informed consent, 201 low-risk ambulatory patients were prospectively studied in either a standard or accelerated pathway after undergoing spinal or epidural anesthesia with procaine, lidocaine, 2-chloroprocaine, or less than 7 mg bupivacaine; epinephrine was not used in any anesthetic. Standard pathway patients (n = 70) were required to void before discharge. Accelerated pathway (n = 131) patients were not required to void. (After randomization of an initial 163 patients to one of the two tracks, 38 additional patients were assigned to the accelerated pathway.) If accelerated pathway patients voided, they were discharged when all other discharge criteria were met. If they did not spontaneously void after block resolution, a bladder ultrasound (BUS) was performed. If the BUS indicated a urine volume of less than 400 ml, the patients were discharged and instructed to return to the emergency department if they were unable to void within 8 h of discharge. If the BUS indicated a urine volume of greater than 400 ml, the patients were reassessed in 1 h and were discharged if they could void spontaneously. If they could not void spontaneously, they were catheterized to facilitate discharge. All patients were contacted the next day to assess the return of normal bladder function.

Results: All standard pathway patients voided without difficulty, and were discharged in 153 +/- 49 (SD) min. 62 patients in the accelerated pathway voided spontaneously after resolution of their block and were discharged in 127 +/- 41 min. 46 patients were discharged with a BUS less than 400 ml in 120 +/- 42 min. 23 patients had a BUS greater than 400 ml: of these, 20 patients voided within an hour and were discharged in 162 +/- 45 min. Three were catheterized after 1 h, and were discharged in 186 +/- 61 min. Mean discharge time for all patients in the accelerated pathway was 22 min shorter than the standard pathway (P = 0.002). No patients had difficulty voiding or returned to the hospital for urinary problems. None reported new urologic symptoms.     

Urodynamic evaluation of surgical outcome in patients with urinary retention due to central lumbar disc prolapse

AIMS: To investigate whether acute urinary retention due to central lumbar disc prolapse is reversible after emergency spinal surgery. METHODS: Eight patients (two males, six females) with a mean age of 31.5 years (range, 18-42 years) with urinary retention due to lumbar disc prolapse were studied. An emergency surgery was performed within 48 hours (mean, 42 hours) after the onset of urinary retention. Urodynamic study was performed before and after the operation. RESULTS: All patients had acontractile detrusor without bladder sensation and four of seven patients had inactive external sphincter on electromyogram at presentation. Two patients were unable to void up to 1 and 5 months after surgery and were then lost for follow-up. The remaining six patients could void with straining or changing their voiding postures (bending forward), postoperatively. A follow-up urodynamic study was performed in all patients from 1 month to 6 years postoperatively. All patients demonstrated acontractile detrusor on cystometrogram. On external sphincter electromyogram, four patients had normal activities. The remaining four patients recovered electromyographic activities, but two of them had denervation motor unit potentials and two had low activities. CONCLUSIONS: Bladder function was irreversible after spinal surgery, whereas urethral function showed a better recovery in patients with acute urinary retention due to central lumbar disc prolapse. However, most of our patients could empty their bladder only by straining or changing their voiding postures postoperatively.     

The etiology of urinary retention after surgery for genuine stress incontinence

Transient postoperative urinary retention after stress incontinence surgery is common, and there is no widely accepted method of hastening the return to normal voiding. The etiology of this retention is poorly understood. Failure of the relaxation of the striated external urethral sphincter has been proposed as an etiologic agent, but has not been documented. Ten patients about to undergo a Burch colposuspension or sub-urethral sling, who demonstrated normal preoperative voiding, were recruited to a study of postoperative retention. Hook-wire electromyographic (EMG)probes were placed into the external urethral sphincter while the patients were under anesthesia, and a suprapubic catheter was placed. We performed instrumented voiding trials 1 or 2 days after surgery while continuously recording urethral EMG and intravesical pressure. Two patients demonstrated normal voiding. Two patients were able to void but demonstrated no EMG silencing. Six patients were unable to void and demonstrated persistent EMG activity. Four of these demonstrated no detrusor contraction, whereas two demonstrated detrusor contractions. All patients resumed normal voiding by clinical parameters within 14 days of surgery. Our study supports other research that suggests that failure of relaxation of the striated urethral sphincter contributes to postoperative urinary retention.     

Predictive factors of early postoperative urinary retention in the postanesthesia care unit

Urinary retention is a common postoperative complication associated with bladder overdistension and the risk of permanent detrusor damage. The goal of this study was to determine predictive factors of early postoperative urinary retention in the postanesthesia care unit (PACU). We prospectively collected, in 313 adult patients, variables including age, gender, previous history of urinary tract symptoms, type of surgery and anesthesia, intraoperative administration of anticholinergics, amount of intraoperative fluids, IV morphine titration, and bladder volume on entry to the PACU. For each patient, bladder volume was measured by ultrasound on entry and before discharge from the PACU. Urinary retention was defined as a bladder volume larger than 600 mL with an inability to void within 30 min. Predictive factors were identified by multivariate analysis. The incidence of urinary retention in the PACU was 16%. In the multivariate analysis only the amount of intraoperative fluids (>or=750 mL; P = 0.02; odds ratio = 2.3), age (>or=50 yr; P = 0.008; odds ratio = 2.4), and bladder volume on entry to PACU (>or=270 mL; P = 0.0001; odds ratio = 4.8) were found to independently increase the risk of urinary retention. Considering the clinical impact of undiagnosed postoperative urinary retention, these results suggest systematic evaluation of bladder volume with a portable ultrasound device in the PACU, especially in patients with risk factors. IMPLICATIONS: In this observational study, the ultrasound monitoring of bladder volume in the postanesthesia care unit (PACU) revealed that postoperative urinary retention occurred with an incidence of 16%. Age (>or=50 yr), amount of intraoperative fluid volume (>or=750 mL), and bladder volume on entry to PACU (>or=270 mL) were independent predictive factors for this complication.     

Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy

Background

Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38 %, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR.

Methods

As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher’s exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05.

Results

During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33 %; p = 0.80), proportion receiving general anesthesia (70 vs. 73 %; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89 %; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2 %).

Conclusion

After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.     

Bladder function after ambulatory surgery

Micturition is a complex process under both involuntary and voluntary control. A variety of pathological conditions, as well as certain surgical and anesthetic procedures cause urinary retention, which may have long lasting consequences. Patients undergoing ambulatory surgery have traditionally been required to void prior to discharge; however, this practice is increasingly being questioned. Ultrasound scanning of the bladder is an accurate method of measuring urine volume in postoperative patients. It may be useful as a non-invasive method of monitoring bladder volume, thus avoiding unnecessary bladder catheterization whilst at the same time preventing prolonged overdistension. We present an algorithm for managing ambulatory patients in both low and high-risk groups for postoperative urinary retention.     

Risk factors of post-operative urinary retention in hospitalised patients

Background: Post‐operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the recovery room in hospitalised patients. Methods: An ultrasound‐determined bladder volume ≥400 ml at arrival in the recovery room was used to define POUR. Multivariate regression analysis was used to identify patient and system factors linked to POUR in 773 consecutive hospitalised patients who had undergone orthopaedic, abdominal, gynaecological or plastic surgery without an indwelling urinary catheter. Results: We found the incidence of POUR to be 13%. The lack of pre‐operative voiding, use of regional anaesthesia, anaesthesia time >2 h and emergency surgery were all independent risk factors for POUR. Conclusions: The detected incidence of POUR at arrival in the recovery room was rather high but had easily identifiable risk factors. We recommend pre‐operative voiding whenever possible. Routine bladder scanning at arrival in the recovery room should be considered, especially after spinal anaesthesia, emergency surgery or when the anaesthesia time exceeds 2 h.     

A型肉毒毒素治疗神经源性尿潴留21例临床观察

目的：观察A型肉毒毒素治疗神经源性尿潴留的疗效,不良反应和有效时间。方法：收集21例神经疾病后尿潴留患者,A型肉毒毒素尿道外括约肌注射,记录治疗前后症状,尿流动力学指标,综合评估A型肉毒毒素治疗神经源性尿潴留的疗效,并记录不良反应和有效时间。结果：A型肉毒毒素治疗神经源性尿潴留,患者症状可明显改善,生存质量评分和国际下尿路综合征症状评分明显改善,尿流动力学指标明显改善,未见明显不良反应,疗效可维持（34-1）（1～5）个月。结论：A型肉毒毒素尿道外括约肌注射是一种治疗神经源性尿潴留的有效方法,短期内对部分患者能够显著改善排尿症状,提高生存质量,且未见不良反应。     

Acute urinary retention: defining the need and timing for pressure-flow studies

OBJECTIVE: To investigate the utility of "late" pressure-flow studies in predicting the outcome of prostatectomy for acute urinary retention. PATIENTS AND METHODS: Fifty-eight patients with acute urinary retention were prospectively assessed using the International Prostate Symptom Score and pressure-flow studies at a median (range) of 24 (13-60) days after the episode of retention, and before transurethral resection of the prostate. Bladder outlet obstruction and bladder contractility were graded using a modified adaptation of Sch?fer's passive urethral linear resistance relation. RESULTS: Fifty-six (97%) patients generated a voluntary detrusor contraction, with a mean (range) detrusor pressure at maximum flow of 72.7 (5-144) cmH2O, and 43 (75%) patients were deemed to be obstructed. Eight (16%) patients failed to void after prostatectomy and required clean intermittent catheterization. There were statistically significant differences between successful and unsuccessful patients in mean (SD) age, at 66.30 (6.9) vs 78.8 (2.6) years (P = 0.001), detrusor instability (49% vs 0%, P = 0.01), inability to void during pressure study (8% vs 75%, P = 0.001), and maximal detrusor pressure in the voiding phase, at 80 (36.0) vs 19 (11.2) cmH2O (P = 0.001). CONCLUSIONS: In patients with acute urinary retention, pressure-flow studies undertaken after a period of adequate bladder rest (> 3 weeks) are useful in predicting the surgical outcome. Old age, absence of bladder instability, inability to void during the pressure-flow study and a maximal detrusor pressure of < 20 cmH2O are associated with a poor outcome after prostatectomy.     

Measurement of trigonal sensitivity as a test of bladder function

A method has been developed for the measurement of sensory receptors that respond to pressure at the base of the bladder and posterior urethra. The application of force to a balloon catheter placed at that part of the bladder regularly results in an urge to urinate. People with normal voiding perceive the urge to void when 245 +/- 47 gm. (standard deviation) of force are applied. Patients with irritative symptoms (urinary frequency and urgency) perceive the urge to void when 132 +/- 50 gm. (p equals 0.0003) are applied. After enucleative prostatectomy more force is required to cause the urge to void (344 +/- 48 gm., p equals 0.0003) and even more force is required after radical prostatectomy (469 +/- 54 gm., p equals 0.0002). Patients with acute urinary retention or urinary stress incontinence were not distinguishable from the normal group. Patients with chronic urinary retention may be divided into 2 subgroups: 1 with normal sensory perception and 1 with reduced perception (526 +/- 32 gm., p equals 1.6 X 10(-9)). Three patients with urinary urgency not associated with frequency did not perceive the urge to void until 541 +/- 21 gm. (p equals 6.2 X 10(-7)) had been applied. Some elderly patients could not reproducibly report the urge to void. When lidocaine was applied topically within the bladder sensitivity was reduced by 210 +/- 114 gm. (p equals 0.003). It is suggested that pressure sensitive receptors in the mucosa or submucosa of the bladder base and posterior urethra have a role in micturition, that their activity can be quantitated and that protocols designed to manage them may have impact on the care of patients with voiding disorders.     

Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling

PURPOSE: We determine which urodynamic parameters can best predict postoperative voiding dysfunction following pubovaginal sling surgery. MATERIALS AND METHODS: The records of 98 consecutive women who had undergone pubovaginal sling surgery with allograft fascia lata between July 1998 and July 2000 were reviewed. Urodynamic and followup data were sufficient for evaluation for 73 patients. Urodynamic and clinical parameters were correlated with urinary retention, time to return of efficient voiding and development of postoperative urgency symptoms. RESULTS: Average time to return of efficient voiding was 3.92 days (median 3). Of 21 women who voided without a detrusor contraction urinary retention developed in 4 (23%) versus 0 of 48 who voided with detrusor contraction (p = 0.007). Urinary retention was defined as the need to perform even occasional self-catheterization. All 4 women with urinary retention had a detrusor pressure of less than 12 cm. H(2)O (0 in 3, 4 in 1). None of the women with a detrusor pressure of greater than 12 cm. H(2)O had urinary retention (p = 0.047). The presence of Valsalva voiding in women without a detrusor contraction did not affect the incidence of urinary retention (11.1%) compared to those who did not demonstrate Valsalva voiding (5.1%) (p = 0.603). Peak flow rate, detrusor instability on preoperative urodynamics and post-void residual urine volume were not associated with postoperative urinary retention. Finally, post-void residual urine volume predicted delayed return to normal voiding (p = 0.001). There were no other urodynamic parameters that were significantly associated with urinary retention, delayed return to normal voiding or postoperative urgency symptoms including peak flow rate, capacity or compliance. CONCLUSIONS: Women who void without or with a weak detrusor contraction are most likely to have urinary retention postoperatively. Therefore, we conclude that preoperative urodynamic evaluation may be used to counsel women regarding the risk of urinary retention following the pubovaginal sling procedure.     

Bilateral extravesical ureteral reimplantation in toilet trained children: Is 1-day hospitalization without urinary retention possible?

PURPOSE: Bilateral extravesical ureteral reimplantation has been associated with urinary retention. We developed a critical pathway and modification of surgical technique to determine whether the bilateral extravesical procedure could be performed in toilet trained children with patients discharged home after a 1-day hospitalization and without urinary retention. MATERIALS AND METHODS: A total of 50 consecutive toilet trained children were evaluated after undergoing bilateral extravesical ureteral reimplantation using a modified technique that limits ureteral dissection, ureteral mobilization and detrusor dissection to as distally as possible so that a 5:1 ratio of tunnel length to ureteral diameter can be accomplished. No surgical dissection occurs in proximity to the obliterated umbilical artery, nor is the artery ligated. Patients follow a strict postoperative critical pathway, and parents receive extensive preoperative and postoperative education. A child is required to fulfill 5 strict criteria to be discharged from the hospital. RESULTS: Patient age ranged from 1.9 to 12.8 years (mean 4.9), with 37 girls and 13 boys participating. All patients were discharged home on postoperative day 1. All patients were able to void postoperatively without any instances of urinary retention. None of the children had acute urinary tract infections or required rehospitalization. All patients had radiographic resolution of the vesicoureteral reflux on postoperative voiding cystourethrogram. CONCLUSIONS: To our knowledge this is the first study to demonstrate that bilateral extravesical ureteroneocystostomy can be performed in selected patients without postoperative urinary retention and with uniform hospital discharge in 1 day. The critical pathway and limited dissection extravesical approach are essential for this success.     

A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate

OBJECTIVE: To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients). RESULTS: In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05). CONCLUSION: Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients.     

缺血性脑卒中患者介入治疗围术期排尿护理流程的构建与应用

目的探讨缺血性脑卒中患者介入治疗围术期排尿护理流程的应用效果。方法将394例患者按住院时间分为对照组206例,观察组188例。对照组采用常规介入治疗围术期排尿护理,观察组应用经专家咨询建立的围术期排尿护理流程进行干预。比较两组围术期排尿情况、术后首次排(导)尿前后的血压变化。结果观察组术前及术后尿潴留发生率显著低于对照组(均P0.01);观察组术后首次排(导)尿前收缩压及舒张压升高幅度显著低于对照组(P0.05,P0.01)。结论围术期排尿护理流程可改善患者围术期床上排尿困难,有效预防尿潴留,有助于维持患者术后血压稳定。     

THE IMPACT OF PROSTATE BIOPSY ON PATIENT WELL-BEING: A PROSPECTIVE STUDY OF VOIDING IMPAIRMENT

PURPOSE: We studied the possible association of transrectal ultrasound guided prostate biopsy with voiding impairment. MATERIALS AND METHODS: A total of 211 consecutive patients were prospectively enrolled. International Prostate Symptom Score (I-PSS), subjective voiding complaints and retention were recorded in 3 personal interviews before biopsy, and on postoperative days 7 and 30. RESULTS: Of the 204 patients who voided via the urethra at biopsy 52 (25%) reported subjective voiding impairment on postoperative day 7, including 12% who defined difficult voiding as mild-1 to 2 points on a 0 to 5 scale, 8% as moderate-3/5 and 5% as severe-4 to 5/5. In 5 of the latter cases (2.5%) acute urinary retention necessitated urethral catheter insertion. Transition zone volume, which was 42 ml. or larger in all patients in urinary retention, was the only independent variable associated with patient report of subjective difficult voiding and acute urinary retention during week 1 after biopsy (p = 0.03). Baseline I-PSS greater than 20 points indicated a risk of an acute transient increase in I-PSS on postoperative day 7. CONCLUSIONS: Transient voiding impairment may be precipitated by ultrasound guided prostate biopsy. To decrease this morbidity appropriate evaluation and possible treatment for bladder outlet obstruction are justified in patients with a larger transition zone and in those with preoperative baseline I-PSS greater than 20 points.     

Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty

BACKGROUND: The impact of preperitoneal mesh after endoscopic totally extraperitoneal inguinal hernioplasty (TEP) on voiding function has not been previously examined. The objectives of the present study were to evaluate the incidence of and risk factors for urinary retention following TEP. METHODS: Three hundred consecutive patients who underwent TEP between June 1999 and September 2001 were recruited. Patient records were reviewed retrospectively to identify those who developed postoperative urinary retention. For each case patient, five age-matched control patients were randomly selected. We then compared the clinical data for the case and control groups. A prospective study of uroflowmetry in patients who underwent bilateral TEP was conducted to evaluate the effect of preperitoneal mesh on voiding function. RESULTS: The overall incidence of urinary retention following TEP was 4% (n = 12). Patients who developed urinary retention stayed in hospital for a significantly longer period than the control group. No significant association was found between the clinical data and postoperative urinary retention. Bilateral TEPs were not associated with significant deterioration in uroflowmetry. CONCLUSIONS: Urinary retention is a frequent morbidity after TEP and significantly prolongs the length of hospital stay. Preperitoneal Prolene mesh did not cause outflow obstruction or alter bladder contractility. No specific clinical factors were identified that might predict postoperative urinary retention, which was probably multifactorial in causation in our patient population.     

A new temporary catheter (ContiCath) for the treatment of temporary, reversible, postoperative urinary retention

Objectives. To describe the initial experience of a newly designed temporary urethral catheter, ContiCath, as an aid in the management of postoperative or temporary outflow obstruction. In patients with normal detrusor and sphincter function, this catheter allows volitional voiding while maintaining an open prostatic urethra.Methods. In a pilot study, 64 nonconsecutive patients with postoperative or temporary urinary retention, at eight clinical trial sites, were enrolled for the placement of this temporary catheter. Three patients did not have the catheter placed because of placement failure because of either a large median lobe or a urethral stricture. The remaining 61 patients were divided into three groups: those with non-neuropathic causes of retention and retention for 1 week or less (37 patients), those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), and those with neuropathic causes of retention and retention for longer than 1 week (5 patients). The ContiCath is placed in the office setting, in the same fashion as a Foley catheter. A blue prolene tether extends from the bulbar urethra to the meatus to assist in the removal of the device. Patients were then reassessed at 3 hours, and at 7, 14, 21, and 28 days, at which point the device was removed.Results. In patients with a neuropathic cause for their retention (5 patients) and those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), only 3 patients were able to void after the catheter was placed. Of the 37 patients with a non-neuropathic cause and retention 1 week or less, controlled voiding was seen in 33 patients (89%). Controlled voiding was defined as the patient’s volitional ability to initiate and stop his urinary stream. There were no complications with catheter placement; however, 8 patients (24.2%) had minor adverse experiences of frequency/urgency (n = 3), incontinence (n = 3), migration of the catheter (n = 1), and pain (n = 1).Conclusions. ContiCath offers an alternative to an indwelling Foley catheter in men with temporary bladder outlet obstruction and urinary retention.