Management of bladder function after outpatient surgery.
BACKGROUND
This study was designed to test a treatment algorithm 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. Patients in category 1 were low-risk patients (n = 227) having non-pelvic surgery and randomly assigned to receive 10 ml/kg or 2 ml/kg of intravenous fluid intraoperatively. They were discharged when otherwise ready, without being required 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 voiding. Fluids administered did not alter incidence of retention or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after discharge.


CONCLUSIONS
In reliable patients at low risk for retention, voiding before discharge appears unnecessary. In high-risk patients, continued observation until the bladder is emptied is indicated to avoid prolonged overdistention of the bladder.
Pavlin
D J
DJ
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA. jpavlin@u.washington.edu
Pavlin
E G
EG
Fitzgibbon
D R
DR
Koerschgen
M E
ME
Plitt
T M
TM
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D001743:Urinary Bladder / Q000503:physiopathology*; D016055:Urinary Retention / Q000628:therapy*