Postoperative Urinary Retention ; Definition, Causes, Symptoms, Diagnosis, Treatment

Postoperative urinary retention (POUR) is a condition where a patient has difficulty urinating after surgery, despite having a full bladder. This condition is quite common and can be caused by several factors related to the surgery and the patient's overall health1. Causes of POUR Anesthesia: The use of anesthetics can numb or paralyze the muscles and nerves required for urination, preventing the brain from receiving signals that the bladder is full. Medications: Post-surgical pain medications, particularly opioids, can cause urinary retention by numbing the region or causing constipation, which puts pressure on the urethra. Surgical Procedures: Procedures involving the abdomen, pelvis, spinal cord, or lower limbs can impact nerves and muscles involved in urination. Surgeries like knee, hip, or colon surgeries are linked to higher incidences of POUR1. Inflammation or Obstruction: Surgeries can cause inflammation or physical obstruction in or near the urinary tract, making it difficult to urinate. Risk Factors Age: Older adults have a higher risk of experiencing POUR. Sex: Generally more common in males, especially those with enlarged prostates. Preexisting Conditions: Conditions like diabetes, renal failure, benign prostatic hyperplasia (BPH), and mental health conditions such as depression can increase the risk. Type of Surgery: Certain surgeries such as orthopedic and abdominal surgeries have higher rates of POUR2. Symptoms Inability to Urinate: A patient cannot urinate despite feeling the need. Bladder Discomfort: Pain or discomfort in the bladder area. Lower Abdominal Pain: Pain below the belly button. Visible Bladder Fullness: In thin individuals, a full bladder can cause abdominal swelling. Diagnosis The condition is diagnosed based on the inability to urinate post-surgery. A healthcare provider may use bladder scans, ultrasound, or catheterization to confirm the diagnosis. Treatment Catheterization: A catheter may be used to empty the bladder, either temporarily or through intermittent catheterization if necessary. Medications: Sometimes medications that relax the bladder or stimulate bladder function may be used. Monitoring and Support: In many cases, POUR resolves on its own within 4 to 6 weeks. Prevention Careful Anesthesia Management: Using anesthetics that minimize the risk of urinary retention. Medication Adjustments: Reducing or modifying the use of opioids post-surgery. Post-Surgical Monitoring: Close monitoring of urination post-surgery to detect and address any issues early #UrinaryRetention