The Sleepy Bladder: Postoperative Urinary Retention

Kim A. Noble, Ph.D., RN, CPANknoble@aspan.org

MNDALSPAN Fall ConferenceSaturday, September 26th, 2015

ObjectivesFollowing attendance in this presentation the participant will:

Describe urinary A&P and regulation of function;Identify the influence of anesthesia on urinary function;Describe the assessment and management of urinary retention;Discuss strategies for the care of the perianesthesia patient with urinary retention.

The Bladder

The bladder….Function;More function;Too much…

Micturition ReflexA muscular bag…A complex interaction…ANS influence.

Postoperative Urinary Retention (POUR)

Acute –Vs- chronic;Multifactorial causes;Linked to many post-op complications.

Incidence of POUR

US Males: 4.5 per 1000; Females: 0.07 per 1000; risk surgeries:

Urologic procedures;Previous voiding problems;Gynecologic procedures;Inguinal hernia repair;Rectal procedures;

Administration of IVF;May be asymptomatic

Risk Factors for Urinary Retention

The geriatric bladderAnesthesiaPainBedrest

Regional Anesthesia & the Bladder

Time to void:Spinal > Epidural

Pharmacology & the Bladder

Anticholinergic agents;Antipsychotic agents;Class I Antiarrhythmic agents;Antispasmodic agents;Antiparkinsonian agents;Atropine;Histamine (H-1) receptor antagonists;Specific anticholinergics:

Chronic airway disease;Overactive bladder Rx.

Pharmacology & the Bladder (con’t)

Antidepressants:Tricyclic antidepressantsSSRI’sSNRI’s

Benzodiazepines

Pharmacology & the Bladder (con’t)

Opioids;-Adrenergic agonists;NSAID’s;Ca++ channel antagonists.

Bladder Scanning

Bladder Volume Instrument rate of catheterization

Urinary Retention Protocol

Urinary Retention Protocol

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