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Tuesday, September 30, 2014
Female urinary retention after surgery
I rececently had abdominoplasty. Trouble with urination began the evening after surgery. Unable to empty bladder. Undetected by surgeon four days after surgery. Also was taking Mepergan for pain. On fifth day urologist was consulted and he diagnosed this as an anesthestia complication and inserted foley catheter. Must wear this for five days. Was the problem caused by the anesthesia or the continued use of Mepergan?
Your problem is known as postoperative urinary retention. Urinary retention is the failure to empty the bladder when it is full of urine. There are a number of things associated with urinary retention after surgery, which is a surprisingly common condition. These include age (older), previous urinary problems, a large amount of fluid received during or after surgery, prostate enlargement (men), site of surgery (hernia), and type of anesthesia (spinal or epidural anesthesia).
In a recent study which used ultrasound to measure the amount of urine in the bladder, the best predictor of urinary retention was the amount of urine in the bladder immediately after surgery. If the full bladder is not emptied this can cause persistent problems because of the prolonged stretching of the bladder (detrusor) muscle. Unfortunately many patients with full bladders after surgery cannot tell that their bladder is full. Ultrasound machines are not usually available (except in research studies!) and recovery room nurses must rely on the patient's symptoms or on their ability to assess the bladder size by feeling the patient's abdomen. This is a very inaccurate method and is why the authors of the study recommend that ultrasound equipment be used routinely in the recovery room.
If urinary retention is recognized in the recovery room, the bladder can be emptied with a urinary catheter. This is a tube placed through the urethra into the bladder. The catheter may be retained for a time or may be used to empty the bladder and then is removed. When surgery is prolonged, or the operation is one in which a lot of fluid must be given or blood is lost, it is usual practice to insert a urinary catheter at the beginning of the procedure. This will help prevent problems of urinary retention in the early recovery period. The decision to place a urinary catheter is usually made by the surgical team and the anesthesiologist.
Another cause of urinary retention is the use of medication with "anticholinergic" properties. Among the many medicines that have this effect is promethazine, one of the drugs contained in Mepergan (a combination of meperidine, a pain killer, and promethazine). While anesthetic factors may have contributed to urinary retention, you can see that this is a not uncommon condition (16% in the study I've quoted), and there are a variety of possible causes, and of methods for detection or early prevention.
I hope you recover soon. For more information I suggest you speak directly with your surgeon and with your anesthesiologist, who is likely to be very glad to respond to your concerns.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University