Management of bladder function after outpatient surgery

  • Pavlin D
  • Pavlin E
  • Fitzgibbon D
 et al. 
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Abstract

Background: This study was designed to test a treatment al- gorithm for management of bladder function after outpatient general or local anesthesia. Methods: Three hundred twenty-four outpatients, stratified into risk categories for urinary retention, were studied. Pa- tients in category l were low-risk patients (n = 227) having non-pelvic surgery and randomly assigned to receive 10 mVkg or 2 ml/kg of intravenous fluid intraoperatively. They were discharged when otherwise ready, without being re- quired to void. Patients in category 2 (n = 40), also presumed to be low risk, had gynecologic surgery. High-risk patients included 31 patients having hernia or anal surgery (category 3), and 31 patients with a history of retention (category 4). Bladder volumes were monitored by ultrasound in those in categories 2-4, and patients were required to void (or be catheterized) before discharge. The incidence of retention and urinary tract symptoms after surgery were determined for all categories. Results: Urinary retention affected 0.5% of category 1 patients and none of category 2 patients. Median time to void after discharge was 75 min (interquartile range 120) in category 1 patients (n = 27) discharged without void- ing. Fluids administered did not alter incidence of reten- tion or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after dis- charge. Conclusion: In reliable patients at low risk for retention, void- ing before discharge appears unnecessary. In high-risk pa- tients, continued observation until the bladder is emptied is indicated to avoid prolonged overdistention of the bladder. (Key words: Anal surgery; hernia; residual volume; ultrasound; urinary retention.) *

Author-supplied keywords

  • Anal surgery
  • Hernia
  • Residual volume
  • Ultrasound
  • Urinary retention

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Authors

  • D. Janet Pavlin

  • Edward G. Pavlin

  • Dermot R. Fitzgibbon

  • Meagan E. Koerschgen

  • Terryn M. Plitt

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