Maintaining micturition in the perioperative period

Abstract

Maintaining micturition in the perioperative period can be challenging because of its low profile, other competing clinical criteria, poorly defined diagnostic criteria, and varying management strategies. Postoperative urinary retention, the main complication of micturition difficulties, has clinical implications in terms of perioperative outcome such as delayed discharge, iatrogenic infection from catheterization with the potential risk of systemic infection, and possible long-term bladder dysfunction. Factors contributing to postoperative micturition problems are multifactorial and anesthesiologists should consider the strategies to minimize the incidence of postoperative urinary retention. Several factors have been identified as increasing the risk of perioperative micturition difficulties including medical comorbidities, surgical type, anesthetic type, and within anesthetic type specific agents such as long-acting neuraxial opioids. Current literature indicates that long-term sequelae are unlikely, with bladder overdistension lasting less than 4 h. Employing strategies aimed at minimizing the disruptions in bladder function can mitigate perioperative micturition problems and subsequent complications. This requires a multifactorial approach. We present identified risk factors, considerations for their modification, as well as a classification and management strategy that incorporates the literature to date.