The use of anxiolytic and parasympathomimetic agents in the treatment of postoperative urinary retention following anorectal surgery |
| |
Authors: | Dr Lester Gottesman MD Jeffrey W Milson MD Dr W Patrick Mazier MD |
| |
Institution: | (1) Ferguson Clinic, 75 Sheldon Boulevard, S.E., 49503 Grand Rapids, Michigan;(2) the Department of Surgery Division of Colon and Rectal Surgery, St. Luke's-Roosevelt Hospital, 53 E. 67th Street, 10021 New York, New York |
| |
Abstract: | Approximately 30 percent of patients undergoing anorectal surgery will develop acute urinary retention. The cause of this
complication is poorly understood. Anxiety, anal distention, bladder distention as a result of vigorous hydration during surgery,
and reflex inhibition of the urinary bladder detrusor muscle secondary to pain have been postulated as contributing factors.
A four-armed prospective, double-blind, randomized trial was carried out to determine whether an anxiolytic agent (midazolam,
5 mg intramuscularly) and/or a parasympathomimetic agent (bethanechol, 10 mg subcutaneously) reduce the incidence of postoperative
urinary retention following anorectal surgery. One hundred thirty-two patients (ages, 18 to 50 years), in acute urinary retention
6 to 12 hours following anorectal surgery, were enrolled. Sixty-nine percent of patients responded to bethanechol. Side effects
were minimal. Midazolam alone had no effect on retention. Bethanechol and midazolam in combination resulted in less retention
than midazolam and a placebo (P<0.05). Bethanechol alone was better than a placebo (P<0.002). Mean intraoperative intravenous fluid volume for the entire study group was 900 cc. Initial postoperative urinary
volumes of patients who failed the treatment protocol were significantly higher than in those responding to bethanechol (mean
of 527 ccvs. 241 cc,P<0.001). The use of an anxiolytic agent was not effective in the treatment of postoperative urinary retention. Bladder distention
may increase the incidence of urinary retention. Behanechol, in a dose of 10 mg subcutaneously, significantly lowered the
incidence of postoperative urinary catheterization and should be considered as initial treatment of postoperative urinary
retention following anorectal surgery.
Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17,
1988. |
| |
Keywords: | Anorectal surgery Urinary retention Midazolam Bethanechol |
本文献已被 SpringerLink 等数据库收录! |
|