Case Of Urinary Retention Research Articles

Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostate biopsy

ObjectivesTo assess whether rectal preparation before transrectal ultrasound (TRUS)-guided prostate biopsy could decrease the rate of infectious complications and to find any possible risk factors affecting the development of complications. MethodsThis retrospective study included 879 cases of TRUS-guided prostate biopsy. All patients received antibiotic prophylaxis with levofloxacin or cefixime orally before biopsy and continually for 7 days after. A total of 456 patients received bisacodyl rectal preparation the night before or on the morning of the biopsy, and 423 did not. Major complications were defined as serious side effects requiring additional treatment. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infection. We evaluated whether rectal preparation before biopsy could decrease infectious complications. Other potential risk factors were also investigated. ResultsMajor complications developed in 47 cases (5.3%), including 1 vasovagal episode, 10 cases of urinary retention, and 46 infectious complications, of which 19 were sepsis and 11 fever without sepsis. Among the potential risk factors, the number of biopsy cores and use of a rectal preparation were statistically significant risk factors influencing the development of infectious complications in multiple logistic regression analysis (P = 0.038 and P = 0.000, respectively). ConclusionsThe number of biopsy cores and prebiopsy rectal preparation use were statistically significant risk factors for infectious complications after prostate biopsy in our study. Thus, we recommend a rectal preparation before prostate biopsy to minimize the risk of infectious complications.

Paravertebral block anesthesia for inguinal hernia repair.

Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. Its attributes are prolonged sensory block with minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. These features are desirable in the practice of ambulatory hernia surgery; hence we initiated the use of thoracic/lumbar paravertebral block for that surgical procedure. Paravertebral block anesthesia was performed on 30 consecutive patients. Block placement took an average of 12.3 minutes, in six cases repeat injection at one or two spinal levels was required due to incomplete blockade. Paravertebral block achieved effective anesthesia in 28 of 30 cases; conversion to general anesthesia was performed for two failed blocks. We are reporting postoperative data on the 28 completed blocks. Supplementation of intravenous sedation or injection of local anesthesia successfully treated transient intraoperative pain in 10 cases. Epidural extension of anesthesia resulting in lower limb numbness and motor weakness delayed the discharge of two patients. There were no other complications of anesthesia and no cases of urinary retention. TIme to onset of pain averaged 15 hours, while duration of sensory block was 13 hours. Patients were prescribed a standing order of naproxen 500 mg B.I.D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.

Two-Stitch Technique for Distal Shaft Hypospadias Repair

The authors present a new technique for distal shaft hypospadias repair using a flip flap fashioned with only two stitches. In raising the flap, the tissues lateral and proximal to the flap are undermined but there is no undermining beneath the flap. The flap is sutured up to the glans with two 4-0 Vicryl sutures. No sutures are placed at the lateral edges of the flap to create the "tube" of the neo-urethra, and no postoperative urinary drainage is used. Thirty-three children with distal shaft hypospadias underwent the "two-stitch" flip flap operation. The complications were one fistula and one case of urinary retention. The technique is an easy method for reconstructing distal penile hypospadias with a very low rate of complications and is suitable for an outpatient surgical setting.

Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital.

To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.

An unusual case of urinary retention due to imperforate hymen.

A 15 year old girl presented to the accident and emergency (A&E) department with a 24 hour history of lower abdominal pain, and was found to have acute urinary retention....

DISTRIBUTION OF POST-VOID RESIDUAL URINE VOLUME IN RANDOMLY SELECTED MEN

We describe the distribution of post-void residual urine volume and its relationship to other urological measurements in a random sample of men. Post-void residual was measured by transabdominal ultrasonography after voiding and prostate volume was measured by transrectal ultrasonography in 477 randomly selected community dwelling white men as part of a baseline urological evaluation. Symptoms were characterized with the American Urological Association symptom index. Acute urinary retention cases with catheterization in the subsequent 3 to 4 years were identified through chart review. The distribution of post-void residual was highly skewed with a median of 9.5 ml., and 25th and 75th percentiles equal to 2.5 and 35.4, respectively. There was a significant correlation of post-void residual with prostate volume (rs = 0.24, p <0.001). The odds of post-void residual greater than 50 ml. were 2.5 times greater for men with prostate volume greater than 30 ml. than those with smaller prostates. In regression analyses post-void residual did not appear to be associated with the American Urological Association symptom index, age or peak urinary flow rate. Men with enlarged prostate volume or post-void residual greater than 50 ml. at baseline were about 3 times as likely to have subsequent acute urinary retention with catheterization during 3 to 4 years of followup. These results suggest little variation in the distribution of post-void residual urine volume across age groups or levels of urinary symptoms and peak urinary flow rate. However, a somewhat stronger relationship was found between residual urine and prostate volume.

Endoscopic extraperitoneal herniorrhaphy. A 5-year experience.

This report reviews our experience with 512 groin hernias treated by a laparoscopic extraperitoneal approach over the past 5 years. We detail the modifications that have been made to this procedure and compare our morbidity and recurrence rates with other laparoscopic and open herniorrhaphy techniques. Between September 1991 and September 1996, 395 male patients underwent 512 hernia repairs by an endoscopic total extraperitoneal approach (TEP). Their ages ranged from 18 to 82 years. There were 267 indirect, 218 direct, 17 pantaloon, and 10 femoral hernias. Of these, 117 were bilateral and 54 were recurrent. All repairs were done with polypropylene mesh. All patients were given general anesthesia except 16 (4.05%) who had epidural anesthesia. Of 512 hernia repairs, seven required conversion to an open procedure (1.3%). There were 19 complications (4.8%), including eight cases of urinary retention, six of groin collection, one bladder injury, one trocar site infection, one transient neuralgia, one cardiac arrhythmia, and one laryngospasm. Follow-up on 354 patients (41 were lost to follow-up) ranged from 6 to 66 months (mean, 38). There were six hernia recurrences (1.69%), but no deaths. Operative time ranged from 15 to 185 min. The endoscopic extraperitoneal approach to groin hernia repair has a recurrence rate comparable with open and other laparoscopic techniques. Operative time has decreased considerably with experience. Familiarity with the technique has eliminated the need for balloon dissectors, cauteries, suction irrigation, Foley catheters, and stapling of the mesh. These advances, along with shortening of the operative time and employment of reusable trocars, have permitted a significant decrease in the cost of the procedure. This study provides the longest follow-up reported with this technique. In experienced hands, the TEP repair produces results that are comparable with the open, tension-free repair and represents a reasonable alternative.

Three Thousand One Hundred Seventy-Five Primary Inguinal Hernia Repairs: Advantages of Ambulatory Open Mesh Repair Using Local Anesthesia

Background: Controversy exists over the relative advantages of open mesh repair compared with open stitching methods and the laparoscopic approach. Study Design: Two thousand nine hundred six (2,906) consecutive unselected adult patients underwent 3,175 primary inguinal hernia repairs using polypropylene mesh, under local anesthesia on an ambulatory basis. The age range was 15–92 years. The study specifically investigated the postoperative course with regard to pain, complications, and time of return to work. Results: There were no postoperative deaths and no cases of urinary retention. Two percent of patients developed a hematoma. The incidence of deep infection was 0.3%. No case of testicular atrophy occurred. Postoperatively 19% of patients used no analgesia at all; 60% used oral analgesics for up to 7 days. There was a gradual decrease in time of return to work over four successive 1-year periods. Manual workers returned to work in 15 days (median) in the first year, reducing to 9 days in the fourth year. The overall median time of return to work across the whole group was 9 days. There were eight recurrences with an 18-month to 5-year followup. Conclusions: Open mesh repair under local anesthesia is an effective day case technique, particularly in the elderly and medically unfit. The economic benefits are enhanced by low morbidity, early return to normal activities and low recurrence rates.

The feasibility, safety and cost of infiltration anaesthesia for hernia repair

Data from 400 consecutive elective ambulatory operations for inguinal hernia under unmonitored local anaesthesia with limited pre-operative testing were prospectively obtained by the use of standardised files and questionnaires to assess the feasibility, patient satisfaction and potential cost reductions for such a technique. The median age of the patients was 59 years, and 29 operations were performed in ASA group III patients. The median postoperative hospital stay was 85 min. Conversion to general anaesthesia was necessary only in two cases, and nine patients needed overnight admission. One week postoperative morbidity was low with one case of transient cerebral ischaemia and one case of pneumonia, but no case of urinary retention. On follow-up, 88% were satisfied with the procedure, including unmonitored local anaesthesia. The cost reduction was at least £160 per patient compared with general/regional anaesthesia. We conclude that elective inguinal herniorrhaphy may be performed routinely under unmonitored local anaesthesia with a low postoperative morbidity, a high satisfaction rate and significant cost reductions.

Combined endoscopic laser ablation of the prostate (ELAP) and temporary prostatic stenting

SummaryDelayed relief of bladder outflow obstruction has limited the use of laser ablation of the prostate (ELAP). This clinical study was to evaluate the combination of temporary prostatic stenting (a new one size stent) with ELAP in 25 consecutive patients with outflow obstruction, including cases of urinary retention, which might accelerate the time to symptomatic benefit or relief of symptoms. Flow rate, residual volume and symptom score were repeated at 6 weeks. The stent was removed under local anaesthetic at 3 months. Twenty-two of 25 voided immediately post-operatively, including 4 of 5 with previous urinary retention. Early stent migration occurred in one case. Late symptomatic migration was not seen. Mean Qmax improved from 8ml/s to 16.5ml/s at 6 weeks. Voiding scores and residual volumes fell. Previously reported ‘prostatitis’ symptoms were not identified. The use of temporary prostatic stenting enables catheter-free ELAP with early improvement of flow and reduction of voiding score.

Minilaparotomy for the ambulatory management of ovarian cysts

OBJECTIVE: The goal of this study was to assess the feasibility, safety, and cost effectiveness of minilaparotomy for the outpatient surgical management of ovarian cysts. STUDY DESIGN: Twenty-four consecutive patients ≤50 years old with 28 complex or persistent ovarian cysts ≤10 cm in maximum size underwent cystectomy or oophorectomy by minilaparotomy. Bupivacaine hydrochloride was injected in the wounds and ketoralac tromethamine (Toradol) administered systemically. The ovaries were reconstructed. RESULTS: All 24 patients were discharged on the day of surgery. There were no readmissions. Mean operative time was 45 minutes. The only complication was a single case of urinary retention managed on an outpatient basis. CONCLUSION: Minilaparotomy is a safe, cost-effective alternative to laparoscopy for the outpatient surgical management of ovarian cysts.

Bladder distention therapy for symptomatic relief of frequency and urgency: A ten-year review

Objective A retrospective review was undertaken to determine the efficacy of bladder distention therapy for the treatment of frequency and urgency, and to determine the relative value of prolonged versus short duration distention therapy. Method Prolonged bladder distention therapy was performed on 14 patients andshort duration distention on 8 patients over a ten-year period. Indications for the procedure included severe urgency, frequency, and incontinence from a variety of etiologies. Results Five of 14 patients (18 distentions, 2 bladder ruptures) who had prolongeddistention, and 3 of 8 patients (9 distentions, 1 bladder rupture) who had short duration distention experienced symptomatic relief on follow-up (p > 0.7). Since there was no difference between the prolonged and short duration groups, the results were combined to yield 8 of 27 successful distentions (30%) in 8 of 22 patients (36%). All patients with detrusor hyperreflexia failed distention therapy. Complications included 3 cases of bladder rupture, 2 cases of urinary retention, and 1 case of urethral stricture. The rates of bladder rupture were identical in both groups (11%). Conclusions The use of prolonged bladder distention therapy has no role in the treatmentof detrusor hyperreflexia, and only limited success in the symptomatic relief of severe urgency, frequency, and incontinence of other etiologies. Equal efficacy of prolonged and short duration distention therapy would tend to favor the use of short duration distention to reduce possible anesthesia complications and cost.

Pregnancy: Operative laparoscopy for ectopic pregnancy: how experienced should the surgeon be?

The purpose of this study was to assess the efficacy of laparoscopic surgery for ectopic pregnancy in a general hospital in Paris, where most of the surgeons are still in training. During a period of 20 months, 100 cases of ectopic pregnancy were diagnosed and treated by the attending residents. Nine cases required a laparotomy due to heavy bleeding or interstitial ectopic pregnancy. Most of the other cases were treated laparoscopically, with either salpingectomy (70 cases) or linear salpingostomy (19 cases). Complications of the laparoscopic surgical procedures were rare. There was one failure of linear salpingostomy that required a second intervention (5.3% failure rate); there was one case of urinary retention that resolved after 48 h; and one case of fever above 38 degrees C that responded well to antimicrobial therapy. In conclusion, we have shown that the current notion that laparoscopic surgery is preferred to conventional abdominal surgery for the treatment of ectopic pregnancy, can be applied to a public gynaecological centre with young inexperienced residents, supervised by experienced gynaecologists.

Does alpha sympathetic blockade prevent urinary retention following anorectal surgery?

Urinary retention is the most common complication after anorectal surgery, with rates as high as 52 percent reported. With the trend toward early discharge, avoidance of this complication is particularly important. Perioperative fluid restriction and the use of short-acting anesthetics have been shown to be effective in decreasing postoperative urinary retention rates but are not applicable in all cases. Reflex sympathetic stimulation, possibly as a result of perianal pain, may lead to increased muscular tone of the internal sphincter at the bladder neck. This theory had led to the effective use of alpha-adrenergic blockade in the treatment of established cases of urinary retention after anorectal surgery, herniorrhaphy, and major pelvic surgery. However, the prophylactic role of alpha blockade after anorectal surgery has not been studied. In a double-blind, prospective, randomized study, 51 patients were treated with either prazosin and alpha-adrenergic blocker or placebo prior to and immediately after elective anorectal surgery. Urinary retention rates were similar in the two groups. At this time, prophylactic alpha-adrenergic blockade is not recommended for the prevention of urinary retention after anorectal surgery.

Disopyramide-Induced Urinary Retention: Report of Nine Cases and Review of the Literature

• Urinary retention is sometimes reported as an adverse reaction during disopyramide phosphate therapy. We report one case of acute renal failure and eight cases of urinary retention. Previous reports of this adverse reaction are summarized. The cause of disopyramide-induced urinary retention is unknown. It is possible that disopyramide or a metabolite via their anticholinergic properties plays some role in the manifestation of urinary tract symptomatology. Treatment of this adverse reaction includes lowering the dose, discontinuing the drug, or possibly using a cholinergic drug to compete with the anticholinergic effects of the disopyramide. ( Arch Intern Med 1983;143:1683-1686)

Paradoxical intention in the treatment of urinary retention

Although most cases of psychogenic urinary retention can be ameliorated by a program composed of various behavioral techniques, there is a small percentage of cases which resists the behavioral treatment of choice. The present multiple case paper focused on the treatment of several resistant cases of functional urinary retention. Following a two week baseline period, each individual was exposed to eight weekly behavioral sessions. Whereas most cases of urinary retention have significantly improved by this time, the five individuals chosen for the present study were dissatisfied with their progress. Thus, following the eighth week, paradoxical intention was employed. Within six weeks treatment for the urinary problem was terminated as all clients were comfortable with this aspect of their daily behavior. It was hypothesized that cases of psychogenic urinary retention which resist behavioral techniques are possibly exacerbated by performance anxiety. Such anxiety can be efficiently handled by paradoxical intention.

Urinary Retention Due to Fecal Impaction

With reference to the article, "Urinary Retention Due to Fecal Impaction in Children" which appeared in Pediatrics (45:292, 1970), I would like to mention that during a few months period spent at the Government Hospital, Ashkelon, Israel, quite a number of cases of urinary retention due to fecal impaction were seen. The presenting cases were mostly young school age children who had eaten large amounts of cactus fruit, the seeds of which caused fecal impaction followed by urinary retention.

Psychogenic urinary retention. Report of two cases.

PSYCHOGENIC urinary retention has often been postulated, but rarely documented. Williams and Johnson1 reported a case in 1956 and stated, "to the best of our knowledge, no such case has been presented previously in the literature." Since then, Chapman2 and Knox3 have each described 1 case of urinary retention based on psychiatric factors. Two additional cases of urinary retention due to emotional disturbance, recently seen at the Peter Bent Brigham Hospital, are reported below.Case ReportsCase 1. S. (P.B.B.H. 5R93), a 17-year-old student, entered the hospital on November 22, 1960, because of vague left-flank pain of 1 month's duration. . . .

URINARY RETENTION DUE TO THE USE OF EPHEDRINE

In 1925 while clinically testing ephedrine sulphate for the most suitable dosage in the treatment of hay fever and asthma, one of us observed that a number of our patients who were taking large doses of ephedrine complained that they had little or no desire to pass urine and encountered some difficulty in relaxation of the sphincter ani. A study of the vegetative nervous supply to the bladder, vesical sphincter and trigon impressed us with the possibility that an extensive use of the drug might produce urinary retention. We at once reported these untoward clinical observations to the manufacturers of the drug and advised that they mention them in their literature. In 1926, in a discussion of the physiologic action of ephedrine, we1attempted to explain the mechanism of the phenomenon described. In 1928, Boston2reported six cases of urinary retention, requiring catheterization, due entirely to the continuous

Two Cases of Urinary Retention Due to Prostatic Sclerosis Relieved by Radiotherm Cauterization

Two Cases of Urinary Retention Due to Prostatic Sclerosis Relieved by Radiotherm Cauterization