Urinary Retention

Question 1

What is acute urinary retention?

Answer 1

Symptomatic inability to completely empty bladder

Question 2

What are the most common signs/symptoms of urinary retention?

Answer 2

Little to no urine passed in post-operative period
Sensation of needing to void without being able to micturate
Pain
Suprapubic mass that is dull to percussion

Question 3

What are common causes for acute retention post operatively?

Answer 3

Uncontrolled pain
Constipation
Infection
Anaesthetic agents - e.g. spinal or epidural

Consider other neurological (cauda equina)

Question 4

What are risk factors for post-op retention?

Answer 4

Age > 50 years
Male
Previous retention
Type of surgery - pelvic urological
Spinal/epidural anaesthetic
Neurological for urological comorbidity
Drugs: antimuscarinic, alpha-antagonists, opiates

Question 5

How can retention be assessed?

Answer 5

USS bladder to identify post-void urine volume - residual volume should be negligible
Check for any underlying reversible causes and that there is adequate pain control
Check patient has stable renal function

Question 6

What is the management for post-op retention?

Answer 6

Conservative:
Watchful watiing
In those that do not resolve - insert catheter and remove - TWOC trial without catheter
If they continue to retain urine, insert catheter again and TWOC in 1-2 weeks in community

Question 7

How much urine can the bladderhold

Answer 7

200ml-400ml in day

800ml in the night