Acute urinary retention occurs in about 4 percent of all surgical patients. 2 It is postulated that urinary retention occurs as the result of catecholamine stimulation of a-adrenergic receptors in the bladder neck and urethral smooth muscle. Increased incidence of urinary retention is likely to occur in elderly males, with excessive fluid administration during surgery, and with the use of spinal or epidural anesthesia.
Patients with urinary retention present with lower abdominal discomfort, urinary urgency, and inability to void. The diagnosis is confirmed by placement of a Foley catheter. The bladder can be safely drained quickly without clamping, since there appears to be no foundation for the fears of hematuria, postobstructive diuresis, and hypotension.3 For patients with normal renal function and no anatomic obstruction, continued catheter drainage is not necessary. For patients with retention after genitourinary procedures, the urologist must be consulted before disposition. Prophylactic antibiotics can be given if the genitourinary tract has been instrumented, if retention is prolonged, or if the patient is at risk for infection.
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