Urinary retention in a healthy female after gynecologic surgery is uncommon. However, many women experience either an inability to void or incomplete emptying of the bladder during the postoperative period. Urinary retention is usually a temporary result of pain or bladder atony resulting from anesthesia.
CLINICAL FEATURES Inability to void is more frequent after operations that involve the urethra and bladder neck, i.e., anterior repair or any modification of the retropubic urethropexy. Most problems with voiding following any of these procedures resolve with time and without medication.
DISPOSITION Retention can be initally relieved with insertion of a Foley catheter for 12 to 24 h. Most patients are able to void after this period. An alternative method is intermittent straight catheterization. Patients are instructed to attempt to void on a timed schedule at intervals of less than 3 h. Patients should be taught to perform self-catheterization if they are unable to void. Self-catheterization can be taught in the emergency department, and the patient should be reassured that voiding function will return in time. If a patient still has trouble voiding after temporary placement of a Foley catheter, the problem may be ureteral spasm, which can be treated with phenazopyridine or oxybutynin.
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