post operative urinary retention

post operative urinary retention
Urinary retention is a problem that some surgical patients face. Voiding was always considered part of the discharge criteria for surgical outpatients. However, it may not be necessary for all patients. The same day surgery nurse and PACU nurse needs to use critical thinking in determining whether a patient needs to void prior to discharge. This educational article on postoperative urinary retention needs to discuss the pathophysiology of postoperative urinary retention, the types of patients who are at risk, and clinical measures the nurse can perform to assist in diagnosing and treating the problem. Controversy:Should a day surgery outpatient have to void in order to be discharged home? ï‚— Which patients can be safely discharged without voiding? ï‚— Which patients are at high risk for urinary retention? ï‚— What measures can we possibly take to prevent the need for readmission to treat urinary retention? Urinary retention is the accumulation of urine in the bladder and inability of the bladder to empty itself.- About 4 percent of people who undergo general anesthesia have urinary retention after surgery Cause: Depressed bladder muscle tone from ï‚— narcotics &anesthetics ï‚— handling of tissues during surgery on adjacent organs such as the Rectum and Vagina Ultrasound scanning of the bladder is often under-used in postoperative assessment. Ultrasound remains a useful instrument in high-risk patients not only because it measures bladder volume; it also guides timing of the catheterization and thus avoids unnecessary bladder and catheter-related complications and delayed disharges . outpatients in the low-risk category group can be sent home without voiding, but those in the high-risk group can be identified, monitored and then catheterized as needed . Several anesthetic and nonanesthetic factors contribute to the development of POUR in the surgical patient. The diagnosis of POUR is often arbitrary, and its true incidence is unknown due to lack of defining criteria. By carefully identifying patients at risk, adopting appropriate anesthetic techniques and perioperative care protocols and accurately monitoring bladder volume by ultrasound, POUR may be prevented and the associated problems minimized. Some “Normalsâ€You Will Need to Know Normal Bladder capacity: 400 –600 mL Desire to void at 250 –300 mL 300 –400 mLper void Residual < 50 mL 1/3 voided volume at night No straining, hesitation, pain or post-void dribble Changes with aging:___________________________ Bladder capacity 250 –300 mL Desire to void (250 –300 mL) Same or less Total volume voided per void decreases Residual < 100 mL Up to 2/3 voided volume after 2000 No straining, pain, or post-void dribble. Here is a good article on the topic: One Resource: Ann Fr Anesth Reanim. 1995;14(4):340-51. [Effects of anesthesia on postoperative micturition and urinary retention]. “Retention of urine is a common postoperative problem associated with the risk of overdistension and permanent detrusor damage (1,2). Damage to the detrusor muscle is characterized by motility problems or even atony, especially in the elderly (3). Furthermore, large retention volume is a predisposing factor for prolonged micturition difficulties because of the need to re-catheterize the patients (1). In the past, a diagnosis of urinary retention relied on detection of a palpably distended bladder or a patient experiencing discomfort in the setting of being unable to void after surgery. Diagnosis was confirmed by bladder catheterization. These techniques are crude and yield imprecise results. They have been used in most studies that attempted to determine incidence and factors influencing postoperative urinary retention (POUR). These investigations found rates ranging from 7% to 52% and reported that certain types of anesthesia, surgery, analgesics, anticholinergics, and unde! rlying medical conditions may predispose patients to develop POUR (4–8). Recent refinements of portable ultrasound technology have enabled rapid, noninvasive, and reliable measurements of bladder volume for postoperative monitoring of urinary bladder volume. This is important because overdistention must not be allowed to persist for more than a few hours to prevent bladder dysfunction Postoperative urinary retention (POUR) is a common complication of surgery and anesthesia. The risk of retention is especially high after anorectal surgery, hernia repair, and orthopedic surgery and increases with advancing age. Certain anesthetic and analgesic modalities, particularly spinal anesthesia with long-acting local anesthetics and epidural analgesia, promote the development of urinary retention Portable ultrasound provides rapid and accurate assessment of bladder volume and aids in the diagnosis and management of POUR. Catheterization is recommended when bladder volume exceeds 600 mL to prevent the negative effects of prolonged bladder overdistention. 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). Retention of urine is a common postoperative problem associated with the risk of overdistension and permanent detrusor damage (1,2). Damage to the detrusor muscle is characterized by motility problems or even atony, especially in the elderly (3). Furthermore, large retention volume is a predisposing factor for prolonged micturition difficulties because of the need to re-catheterize the patients (1). They have been used in most studies that attempted to determine incidence and factors influencing postoperative urinary retention (POUR). ”

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