The Sleepy Bladder Postoperative Urinary Retention MNDALSPAN Fall

The Sleepy Bladder: Postoperative Urinary Retention MNDALSPAN Fall Conference Saturday, September 26 th, 2015 Kim A. Noble, Ph. D. , RN, CPAN knoble@aspan. org

Objectives Following 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 Reflex A 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 bladder Anesthesia Pain Bedrest

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 antidepressants SSRI’s SNRI’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

References Buchko, B. L. & Robinson, L. E. (2012, An evidence-based approach to decrease early postoperative urinary retention following urogynocologic surgery, Urologic Nursing, 32(5), 260 -273. Drain, C. B. & Odom-Forren, J. (2009). Perianesthesia Nursing: A Critical Care Approach, 5 th ed. , St. Louis, MO: Saunders. Faas, C. L. , Acosta, F. J. , Camobell, M. , O’Hagan, C. E. , Newton, S. E. & Zagalaniczny, K. (2002). The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary retention and mobility following inguinal herniorrhaphy, AANA, 70(6), 441 -447. Joelsson-Alm, E. , Nyman, C. R. , Lindholm, C. , Ulfvarson, J. & Svensen, C. (2009). Perioperative bladder distention: A prospective study, Scandinavian Journal of Urology and Nephrology, 43, 58 -62. Joelsson-Alm, E. , Ulfvarson, J. , Nyman, C. R. , Divander, M. & Svensen, C. (2012). Perioperative ultrasound monitoring can reduce postoperative bladder distemtion: A randomized study, Scandinavian Journal of Urology and Nephrology, 46, 84 -90. Lau, H. & Lam, B. (2003). Management of postoperative urinary retention: A randomozed trail of in-out versus overnight catheterization, ANZ J, 74, 658 -661. Palese, A. , Buchini, S. , Deroma, L & Barbaone, F. (2010). The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis, Journal of Clinical Nursing, 19, 2970 -2979. Verhamme, K. , Sturkenboom, C. , Stricker, B. H. & Bosch, R. (2008). Drug-induced urinary retention: incidence, management and previention, Drug Safety, 31(5), 373 -388.