It is particularly common in older people having hip or knee replacement surgery. This invasive method can lengthen hospital stay and lead to more problems such as infections and damage to the bladder. It can be incapacitating, undignified, distressing and uncomfortable.
Some people leave hospital with a tube still in place. There are many triggers for PO-UR, including age and gender, type of surgery, anaesthetic or pain killers. This project came from an idea by patient contributor Nick, who experienced post-operative urinary retention and was given a catheter after three different common non-urgent surgical procedures. He has worked as a researcher alongside the rest of the project team in a pioneering form of co-production.
This project aimed to review the literature, to identify the factors influencing whether a patient will develop PO-UR and what can be done to prevent and treat it.
Reducing fluids and using a catheter during surgery were associated with a lower risk of PO-UR.
Prevention of Post-operative Urinary Retention (POUR)
Giving tamsulosin a drug used to help men with prostate disease before surgery can reduce the number of people who develop PO-UR. All the studies of tamsulosin were in men and none were in UK settings, so more studies are needed to see if similar effects are found in women and in UK settings. Replacing or avoiding morphine in the anaesthetic, administering the anaesthetic in certain ways, and getting patients up and moving as soon as possible after their operation reduced the chance of developing PO-UR.
For people who developed it, a small number of studies also suggested that a hot pack or warm gauze and a warm coffee could help. This package involves providing hospital staff with training and advice to:. Reducing PO-UR should improve patient experience and dignity, shortening their time in hospital and speeding recovery, as well as saving money for the NHS. They offer care to the people of Bristol, Weston-Super-Mare and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation.
They are the largest centre for medical training and research in the South West. The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. Preventing post-operative urinary retention. Project aims This project aimed to review the literature, to identify the factors influencing whether a patient will develop PO-UR and what can be done to prevent and treat it.
This package involves providing hospital staff with training and advice to: Avoid using morphine or reducing the dose, wherever possible Change other aspects of the anaesthesia or analgesia Get people moving as soon as possible after their operation Reduce fluids as far as is safe, before and during the operation Provide a hot caffeinated drink and hot pack placed on the abdomen around two hours after the operation.
What next? University of Bristol The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff.Urinary retention is a common complication of surgery and anaesthesia. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery.
If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections.
This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.
Nursing Standard. Anaesthesia - bladder function - catheterisation - post-operative care - surgery - urinary retention - voiding dysfunction. Alternatively, you can purchase access to this article for the next seven days.
Ok, I Agree More Info.Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention POUR.
The authors review the overall incidence and mechanisms of POUR associated with surgery, anesthesia and analgesia.
Post-operative urinary retention
Ultrasound has been shown to provide an accurate assessment of urinary bladder volume and a guide to the management of POUR. Recommendations for urinary catheterization in the perioperative setting vary widely, influenced by many factors, including surgical factors, type of anesthesia, comorbidities, local policies, and personal preferences.
Inappropriate management of POUR may be responsible for bladder overdistension, urinary tract infection, and catheter-related complications. An evidence-based approach to prevention and management of POUR during the perioperative period is proposed. BLADDER catheterization is a common procedure during inpatient major surgery that allows monitoring of urine output, guides volume resuscitation, and serves as a surrogate marker of hemodynamic stability.
With an increase in outpatient and fast-track surgical procedures, perurethral catheterization is restricted to fewer procedures and for a limited time. Awareness and identification of patients at risk of developing postoperative urinary retention POUR thus assumes greater significance. POUR has been defined as the inability to void in the presence of a full bladder. The widely varying reported incidence of POUR reflects its multifactorial etiology and the lack of uniform defining criteria.
This paper reviews the physiology of micturition and analyzes the perioperative factors that contribute to POUR. Evidence-based guidelines for the management of POUR are also provided. The bladder is composed of a body formed by the detrusor muscle and a funnel-shaped neck. The neck has an internal layer of smooth muscle that surrounds the internal meatus of the bladder—the internal urethral sphincter IUS.
The external urethral sphincter is formed collectively by the overlying striated muscle fibers of the pelvic floor. The adult urinary bladder has a capacity of to ml. The parasympathetic fibers cause contraction of the detrusor and relaxation of the neck, permitting micturition. The sympathetic fibers, in contrast, influence the relaxation of the detrusor and close the internal urethral sphincter.
These two systems are governed by spinal reflexes, which are regulated by two pontine brainstem centers, the Pontine Storage Centre and the Pontine Micturition Centre. The voluntary control of the bladder becomes fully developed by the first few years of life and involves the coordination among the frontal cortex, the pontine centers, and the spinal segments influencing bladder control.
During micturition, two phases can be distinguished, the storage phase and the emptying phase. The high compliant bladder allows for storage of a large volume of urine without an increase in the intravesical pressure. The first urge to void is felt at a bladder volume of ml.
The tension receptors in the bladder wall are activated at a volume of approximately ml, creating the sense of fullness. Activation of the parasympathetic neuron stimulates efferent pelvic nerves that lead to contraction of the detrusor muscle.
Detrusor contractions last only a few seconds, substantially raising the intravesical pressure from a resting pressure of 40 mm H 2 O to a few hundred mm H 2 O. When the intravesical pressure reaches the voiding threshold, the detrusor contractions increase in intensity, frequency, and duration. This creates a complete and synchronous contraction of the detrusor muscle, allowing the bladder to empty quickly and efficiently.
If micturition is not desired or is inconvenient, afferent stimuli from the stretch receptors of the bladder along with the proprioceptive afferents of the urethra, penis, vagina, rectum perineum, and anal sphincters activate the sympathetic system and external urethral sphincter motor neurons and simultaneously inhibit the parasympathetic system. The final effect is to prevent micturition through the contraction of the sphincters and the relaxation of detrusor muscle.
Furthermore cerebral input from the frontal cortex and the pontine centers also aids in inhibiting the parasympathetic neurons and activating the sympathetic pathways.Study record managers: refer to the Data Element Definitions if submitting registration or results information. It results in patient discomfort, embarrassment, interference with therapies, and significant nursing burden.
More importantly, urinary retention necessitates use of intermittent catheterization or placement of an indwelling urinary catheter, which exposes the patient to an increased risk of urinary tract infection UTIurethral injury, and potentially increased hospital length of stay and cost.
For these reasons, a safe and effective intervention for preventing POUR would be highly valuable. Despite such a need, no contemporary studies exist evaluating medications that can be used to prevent POUR in broad general surgery populations.
To address this gap, the investigators have designed a prospective, randomized, double-blind, placebo-controlled trial to test the hypothesis that preoperative loading with tamsulosin will prevent POUR in patients undergoing elective, inpatient complex intra-abdominal surgery and thereby lead to improved short-term outcomes.
Tamsulosin is a safe and widely-used selective alphaA adrenergic blocker commonly used for the treatment of lower urinary tract symptoms in men with benign prostatic hypertrophy.
It has also been shown to have some benefit in reducing POUR and need for catheterization in men undergoing inguinal hernia repair and other outpatient urologic procedures.
This study is a randomized, double-blind, placebo-controlled trial in which patients scheduled for inpatient complex intra-abdominal surgery will be randomized to receive either tamsulosin or placebo for 7 days pre-operatively, and up to several days post-operatively, and then rates of POUR will be compared between the two groups Aim 1.
A retrospective analysis of the data will be used to identify risk factors for POUR and subgroups of patients that would derive the greatest benefit from preoperative tamsulosin Aim 2. Furthermore, short-term outcomes, including rate of urinary tract infection UTI and hospital length of stay, will be compared between the tamsulosin and placebo groups Aim 3.
Enrolled subjects will be randomized using a blocked, stratified randomization process to either tamsulosin or placebo. Stratification variables include gender, pelvic vs non-pelvic surgery, and International Prostate Symptom Score IPSS survey results which is a measure of baseline lower urinary tract symptoms.
After a 7-day treatment period, subjects will undergo surgery as scheduled, and then the assigned treatment will be continued for up to a total of 14 days until the subject either has return of normal voiding function, has required replacement of an indwelling urinary catheter, or is discharged from the hospital.
Placebo capsule orally once daily, dosed 30 minutes after dinner or before bed, starting 7 days before surgery and continuing for days postoperatively. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.
For general information, Learn About Clinical Studies.
Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information. Search for terms x. COVID is an emerging, rapidly evolving situation. Save this study. Warning You have reached the maximum number of saved studies Prevention of Post-operative Urinary Retention POUR The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Results First Posted : April 23, Last Update Posted : September 25, Study Description.
The purpose of this study is to determine if tamsulosin "FLOMAX" is effective in preventing post-operative urinary retention following abdominal surgery. It can be described as the inability to initiate urination or properly empty one's bladder following surgery. It is usually self-limited, but it requires the use of catheterization to empty the bladder in order to prevent further injury to the bladder or kidneys and to relief the discomfort of a full bladder.
Tamsulosin is a medication that is commonly used in men with urinary symptoms related to an enlarged prostate. There is some evidence to suggest that it may also potentially be beneficial for preventing post-operative urinary retention.
Therefore, in this research study, subjects scheduled for abdominal surgery will be randomly assigned to take either tamsulosin once-daily or placebo once-daily for one week leading up to surgery, and up to several days after surgery.Advanced Search. This Article. Academic Rules and Norms of This Article.
Citation of this article. Post-operative urinary retention: Review of literature. Corresponding Author of This Article. Publishing Process of This Article.
Research Domain of This Article. Article-Type of This Article. Open-Access Policy of This Article. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Number of Hits and Downloads for This Article. Total Article Views All Articles published online. Times Cited of This Article. Journal Information of This Article. Published by Baishideng Publishing Group Inc.
All rights reserved. World J Anesthesiol. Definitive Equivocal Unrelated Age [ 135910 ] ; Pre-existing neurologic abnormality stroke, cerebral palsy, multiple sclerosis, diabetic and alcohol neuropathy, poliomyelitis [ 19 ] ; Bladder volume on entry to PACU [ 3 ] ; Surgical procedure anorectal, colorectal, urogynaecolgical [ 571112 ] ; Intraoperative aggressive fluid administration [ 13561113 ] ; Postoperative pain and need for postoperative analgesia [ 5791114 ] ; Postoperative opioid use [ 1511 ] Gender [ 137915 ] ; Preoperative urinary tract pathology [ 5791617 ] ; Anaesthetic technique general anaesthesia vs neuraxial anaesthesia [ 1269101217 ] ; Duration of surgery [ 135 - 718 ] American Society of Anaesthesiologists physical status [ 18 ] ; Presence of pelvic drain [ 18 ] ; Pelvic infection [ 18 ].
Method of diagnosis Ref. Authors recommended use of indwelling catheter for management of POUR Bladder catheterization Requirement of bladder catheterization Lau et al [ 10 ] To ascertain optimal management of POUR in-out catheterization vs indwelling catheter patients undergoing elective inpatient general surgery In-out catheterization recommended for POUR over indwelling catheter Need for catheterization within 24 h postoperatively Toyonaga et al [ 7 ] Incidence and risk factors for POUR after surgery for benign anorectal diseases patients who underwent surgery for benign anorectal diseases under SAB Incidence of POUR was Incidence of urinary retention was lower in paravertebral group Need for catheterization Peiper et al [ 45 ] To compare perioperative outcomes after LA vs GA for inguinal hernia repair patients operated for inguinal hernia repair Patients in LA group had lower intensity of pain and had fewer complications e.
Write to the Help Desk. Age [ 135910 ] ; Pre-existing neurologic abnormality stroke, cerebral palsy, multiple sclerosis, diabetic and alcohol neuropathy, poliomyelitis [ 19 ] ; Bladder volume on entry to PACU [ 3 ] ; Surgical procedure anorectal, colorectal, urogynaecolgical [ 571112 ] ; Intraoperative aggressive fluid administration [ 13561113 ] ; Postoperative pain and need for postoperative analgesia [ 5791114 ] ; Postoperative opioid use [ 1511 ].Postoperative urinary retention POUR is one of the postoperative complications which is often underestimated and often gets missed and causes lot of discomfort to the patient.
POUR is essentially the inability to void despite a full bladder in the postoperative period. Multiple factors and etiology have been reported for occurrence of POUR and these depend on the type of anaesthesia, type and duration of surgery, underlying comorbidities, and drugs used in perioperative period. Untreated POUR can lead to significant morbidities such as prolongation of the hospital stay, urinary tract infection, detrusor muscle dysfunction, delirium, cardiac arrhythmias etc.
This has led to an increasing focus on early detection of POUR. This review of literature aims at understanding the normal physiology of micturition, POUR and its predisposing factors, complications, diagnosis and management with special emphasis on the role of ultrasound in POUR.
Core tip: Postoperative urinary retention is considerable concern inpatients after the surgical intervention. It not only dissatisfies the patient but also confounds many serious concerns in immediate postoperative period. It is reported variably with many etiological factors. Postoperative urinary retention POUR is another such complication which is often underestimated and often gets missed. This wide range may be due to absence of a uniformly accepted definition for POUR along with its multifactorial etiology [ 1 - 3 ].
Occurrence of POUR may depend on the various reasons like the type of anaesthesia, type and duration of surgery, underlying comorbidities, and drugs used in perioperative period. Untreated POUR can lead to significant morbidities such as prolongation of the hospital stay, urinary tract infection, detrusor muscle dysfunction, delirium, cardiac arrhythmias etc [ 45 ]. The use of ultrasonography to diagnose POUR has gained popularity in recent years. The various advantages of ultrasound as a diagnostic tool include its non-invasive technique, high accuracy, and absence of any risk of trauma or infection.
This review aims at understanding the normal physiology of micturition, POUR and its predisposing factors, complications, diagnosis and management with special emphasis on the role of ultrasound in POUR.
This review is being written with an objective to summarize the literature related to POUR. The published literature related to POUR has been included and all study designs including systematic reviews and editorials were studied.
During the search, any published literature not related to POUR were excluded. The literature published till June were included in this review. Bladder is supplied with sympathetic, parasympathetic and efferent somatic fibres. Visceral afferent fibres, also called stretch receptors, arise from bladder wall.
Micturition is a complex process which can be divided into two phases viz storage phase and voiding phase. Storage phase is mediated through sympathetic innervation whereas voiding phase by parasympathetic fibres. Overall, micturition is a spinal reflex which is further governed by brainstem centres. The bladder wall is a compliant muscular organ and can accommodate increasing volume of urine without much increase in pressure till a particular volume. The capacity of the normal bladder is mL.
The first urge to void occurs when the bladder volume is approximately mL whereas the sensation of fullness occurs at mL. The pelvic splanchnic nerves carry the reflex from the stretch receptors to the brainstem through afferent fibres when the bladder contains urine more than mL. This activates the voiding phase and the parasympathetic fibres conduct the efferent pathway.
Detrusor muscle contraction by parasympathetic fibres and removal of inhibition of motor cortex is required for voiding of urine.
Preventing post-operative urinary retention
As soon as urine enters the posterior urethra this motor cortex inhibition is removed by pudendal afferents which results in relaxation of pelvic floor, descent of levator ani muscle and voiding of urine [ 16 ]. The perioperative period can potentially affect the normal physiology of micturition. This can be attributed to the effects of anaesthesia, the surgical procedure performed, the intraoperative physiologic stressors, drugs, pain, anxiety etc.
Many drugs used in perioperative period such as sedatives, analgesics and anaesthetic agents are known to interfere with the micturition pathway [ 57 ]. Opioids, commonly used for both intraoperative and postoperative analgesia, are known to cause urinary retention by blunting the sensation of bladder fullness due to parasympathetic inhibition along with increasing the sphincter tone due to augmented sympathetic activity. Neuraxial opioids have been reported to have greater incidence of urinary retention as compared to intravenous administration.
General anaesthetics also predispose to urinary retention as they cause relaxation of smooth muscle and hence decrease bladder contractility.For more information, see our blog post or read this paper. An array of pairs where the first element of each pair is one of the unique values found in the field and the second element is the count. Only available when the number of distinct values is less than or equal to 32. A measure of 'peakiness' or heavy tails in the field's distribution.
A status code that reflects the status of the dataset creation. Number of milliseconds that BigML. Information about ill-formatted fields that includes the total format errors for the field and a sample of the ill-formatted tokens. Example: "category": 1 description optional A description of the dataset up to 8192 characters long. Example: "description": "This is a description of my new dataset" fields optional Updates the names, labels, and descriptions of the fields in the new dataset.
Example: "description": "This field is a transformation" descriptions optional A description for every of the new fields generated. Example: "fields": "(window Price -2 0)" label optional Label of the new field. Example: "label": "New price" Labels for each of the new fields generated.
Example: "name": "Price" names optional Names for each of the new fields generated. Example: "This is a description of my new sample" name optional The name you want to give to the new sample. This will be 201 upon successful creation of the sample and 200 afterwards. Make sure that you check the code that comes with the status attribute to make sure that the sample creation has been completed without errors and that it is still available in the in-memory cache.
This is the date and time in which the sample was created with microsecond precision. True when the sample has been created in the development mode.
In a future version, you will be able to share samples with other co-workers. It includes the fields' dictionary describing the fields and their summaries and the rows. A description of the status of the sample.
This is the date and time in which the sample was updated with microsecond precision. Each entry includes the column number in the original dataset, the name of the field, the type of the field, and the summary. See this Section for more details. A list of lists representing the rows of the sample. Values in each list are ordered according to the fields list.