Running head: MCJ POSTOPERATIVE URINARY RETENTION
MCJ Postoperative Urinary Retention
Susan L. Vansteel
Ferris State University
1
MCJ POSTOPERATIVE URINARY RETENTION
2
Article Annotation1
Dreijer , B., Moller , M. H., & Bartholdy , J. (2011, January 4). Post-operative urinary retention
in a general surgical population. European Journal of Anaesthesiology, 28(3), 190-194.
doi:10.1097EJA.0b013e328341ac3b
The information in the article is presented by physician from the Department of Anesthesiology,
Copenhagen University Hospital. This study was limited to evaluate urinary retention in
adult general surgical patient. Predisposing risk factors identified in this study may be
applied to other surgical specialties for research analysis. this information is useful The risk
factors identified can be applied to any type of surgery and will assist in minimizing
postoperative urinary retention.
Article Annotation 2
Baldini, G., Bagry, H., Apikian, A., & Carli, F. (2009, May). Postoperative urinary retention:
anesthetic and perioperative considerations [Electronic version]. American Society of
Anesthesiologists, Inc, 110(5), 1139-1157. doi:10.1097/ALN.0b013e31819f7aea
The information has been researched by a research fellow, professor of urology and
anesthesiologist from the Department of Anesthesia, McGill University Health Centre in
Montreal, Canada. The information presented in this article is a compilation of prior studies that
have recommended methods of prevention and management of postoperative urinary retention.
Various types of anesthesia agents affect the normal anatomy and physiology of bladder function
and micturition. There is 5% to 70% of reported incidence of urinary retention postoperatively.
The recommendations provided for managing postoperative urinary retention are relevant and
adoptable.
Article Annotation 3
Ruhl, M., (2009, May). Postoperative voiding criteria for ambulatory surgery patients
[Electronic version]. Association of Operating Room Nurses, 89(5), 871-874.
Maureen Ruhl, MSN, RN is a nurse educator at the University of Pennsylvania Hospital in Philadelphia.
She describes the frustration on behalf of the ambulatory patient when there are complications from
urinary retention. The unplanned hours required to stay in the hospital are costly to the organization
and the patient. Nurses have an opportunity through evidence based practice to develop guidelines that
will optimize an ambulatory patient surgical experience. This article clearly illustrates the same the need
to manage postoperative urinary retention so to optimize the patient experience.
MCJ POSTOPERATIVE URINARY RETENTION
3
Article Annotation 4
Shadle, B., Barbaro, C., Waxman, K., Connor,S., & Von Dollen, K., (2009, October). Predictor
of postoperative urinaty retention [Electronic version]. American Surgeon, 75(10), 922-924.
The study for postoperative urinary retention was conducted at Cottage Hospital, Santa Barbara, CA. by
a team of 4 physician and a nurse. In January 2009, the findings were presented at the 20th Annual
Scientific Meeting of the Southern California Chapter of the American College of Surgeon. The study
focused on determining what predictive factors resulted in a patient having postoperative urinary
retention. The data for bladder volume was captured prior, immediately after surgery, and at discharge
from the recovery room using ultrasound. The results demonstrated a 5% rate of urinary retention
postoperatively. The study results may be low due to limited type of surgeries, but confirmed the
commonalities in risk factors.
MCJ POSTOPERATIVE URINARY RETENTION
MCJ Postoperative Urinary Retention
Table 1
Postoperative Urinary Retention
1.
Purpose (all reasoning has a
purpose)
2.
Questions at issue or central
problem (all reasoning is an
attempt to figure something out,
to settle some question, solve
some problem)
Improve the overall surgical outpatient
experience as it relates to postoperative urinary
retention
After discharge from outpatient surgery some
patients experience an inability to void. This
dysfunction requires medical intervention. What
are the factors contributing to POUR? What
percent of the surgical population will experience
this condition? What volume should be defined
as urinary retention and require an intervention?
How many failures of conservative management
do you allow a patient before placing an
indwelling catheter?
3.
Point of view (all reasoning is
done from some point of view;
think about the stakeholders)
Patients are dissatisfied when a return visit to a
medical facility following surgery is required for
POUR. Treatment for urinary retention can result
in undue patient stress, countless hours in
emergency, and an additional cost burden to the
facility and patient.
4.
Information (all information is
based on data, information,
evidence, experience,
research)
Depending on the literature reviewed and the
method of the study, incidence of POUR can
range from zero to 70 percent. Identify
commonalities of the returning population
through retrospective chart review. Data points to
consider are age, gender, type of surgery,
duration of surgery, amount of IV fluid
administered, and type of anesthesia
5.
Concepts and ideas (all
reasoning is expressed through,
and shaped by, concepts and
ideas)
The normal urge to void occurs at around 300ml.
Normal bladder capacity is 400to 600ml. Over
distension of the bladder will inhibit the urge to
void.
6.
Assumptions (all reasoning is
based on assumptions-beliefs
Many outpatients are not required to void prior to
discharge after surgery. It is often assumed that
4
MCJ POSTOPERATIVE URINARY RETENTION
we take for granted)
7.
the patient will void without difficulty. However,
urinary retention is a postoperative complication
of surgery.
Implications and consequences Managing POUR result in increased length of
(all reasoning leads somewhere. stay and increase costs to the organization.
It has implications and when
acted upon, has consequences) Intervention of catheterization causes patient
discomfort and may damage prostrate and
urethra. There is also a risk of infection with
indwelling catheters
8.
Inference and interpretation (all
reasoning contains inferences
from which we draw conclusions
and give meaning to data and
situations)
To reduce this reoccurring problem, patients need
to void immediately prior to surgery.
Intraoperative urinary catheterization will be
recommended for surgical procedures with
duration greater than 2 hours. Bladder volumes
will be measured in the recovery utilizing
ultrasound technology for patients who receive
spinal anesthesia or have surgical durations
greater than 2 hours without urinary
catheterizations.
5