u r i n a r y c o m p l i c a t i o n s

Question 1

urinary retention risk factors

Answer 1

Age >50yrs

Male gender

Previous retention

Type of surgery = Including pelvic or urological surgery

Anaesthetic type (spinal or epidural)

Neurological or urological co-morbidities

Medication (e.g. antimuscarinics, alpha agonists, opiates)

Question 2

assessment of urinary retention

Answer 2

ultrasonic bladder scan to identify the post-void residual urine volume

Question 3

clinical features of urinary retention

Answer 3

Little or no urine passed in the post-operative period

A sensation of needing to void, without being able to micturate

suprapunic mass dull on percussion

Question 4

common causes of acute urinary retention post operatively

Answer 4

uncontrolled pain, constipation, infection, or anaesthetic agents* (e.g. spinal or epidural use)

Question 5

management of acute urinary retention

Answer 5

manage causes

any significant retention will require catheterisation (at least overnight). Patients can have their catheter removed shortly after (often termed a Trial Without Catheter (TWOC))

Question 6

UTI post op complications

Answer 6

have higher rates of mortality and longer length of stay,

Question 7

common causative organisms of UTI

Answer 7

E. coli, Klebsiella sp., Enterobacteur sp., Proteus sp., Pseudomonas sp., and Staphylococcus sp

Question 8

risk factors for UTI

Answer 8

ge > 60yrs
Female
Significant co-morbidities (e.g. renal failure, diabetes mellitus)
Catheterisation (Fig. 1) or recent instrumentation
Pregnancy
Urinary retention or renal stones

Question 9

Clinical features for UTI

Answer 9

rinary frequency, urgency, and dysuria. On examination, these patients may have mild suprapubic pain and be pyrexial.

Question 10

UTI should be considered in patients presenting with

Answer 10

With delirium
Septic (without a clear foci of infection)
In acute urinary retention

It is also important to assess for features of pyelonephritis as well (such as loin pain, renal angle tenderness, or pyrexia).

Question 11

investigations for UTI

Answer 11

urine dipstick*
mid stream urine for MC&S
if systemic features/ sepsis = FBC, CRP, and U&Es, blood cultures, VBG

Question 12

investigations for UTI

Answer 12

urine dipstick*
mid stream urine for MC&S
if systemic features/ sepsis = FBC, CRP, and U&Es, blood cultures, VBG

Question 13

management of UTI

Answer 13

he patient is well hydrated (either through PO or IV routes) and maintains a satisfactory urine output (>0.5mL/kg/hour)

Definitive management is via antibiotic therapy, referring to your local antimicrobial guidelines; classically trimethoprim, nitrofurantoin, or co-amoxiclav are typical antibiotic choices.

If pt with catheter = change it before starting abx