Occurrence Of Urinary Retention Research Articles

Задержка мочеиспускания как следствие родовых травм матери

Postpartum urinary retention (ischuria, PUR) is the absence of spontaneous urination in a woman in labor more than 6 hours after the birth of a child or a condition in which the residual volume of urine after urination is less than 150 cm3. The ischuria pathophysiology is not fully understood, but there are several hypotheses that may cause the occurrence of urinary retention in the early postpartum period. For example, trauma to the pelvic floor muscles and innervation can lead to decreased bladder sensitivity, and swelling of the ureters and vagina after childbirth can lead to urinary tract obstruction. Despite the frequency of complications in the form of ischuria, the maternity hospital staff does not pay sufficient attention to screening for these problems in the early and late postpartum periods. This literature review examines risk factors, clinical presentation, prevention methods and examples of treatment for this dangerous complication.

Pelvic neural injuries and acute voiding changes in rat models of radical hysterectomy.

To establish experimental models of radical hysterectomy based on Querleu-Morrow classification, and clarify the quantitative evaluation of pelvic neural injuries and acute voiding changes postoperatively. Female Sprague Dawley rats were randomized and received sham operation, type A, B1, C1 and C2 radical hysterectomies (as the injury gradually increased), respectively. The excised specimens were collected for hematoxylin and eosin staining and Pgp9.5 (pan-neuronal marker) immunohistochemistry to evaluate the facial and neural resection of paracervix. At 21 days after operation, 5 rats in each group were used for urine spot test, awake cystometry and leak point pressure test, and the other 5 ones were used for hematoxylin and eosin staining of bladder and pelvic neural plane, and Masson's trichrome staining of bladder. Paracervical Pgp9.5 immunohistochemistry revealed that the resected neural area in C2 group was significantly larger than that in type A, B1, and C1 groups. Compared with type A and B1 groups, the excised paracervical facial area was significant higher in type C1 and C2 groups. The occurrence of urinary retention was 0%, 10%, 40% and 100% in type A, B1, C1 and C2 groups, respectively, which was further confirmed by average residual volume. The incidence of neurogenic bladder and its severity gradually increased from type A to type C2 groups, consistent with the findings of leakage point pressure, bladder size, bladder weight, pathological changes and collagen deposition. Neuropathological evaluation revealed neural injuries involved the main components of pelvic neural plane. The novel rat models of radical hysterectomy based on Querleu-Morrow classification revealed the structural and functional changes of voiding after operation, which reflected the situation in humans.

Prolonged second stage of labor is associated with persistent urinary retention after forceps delivery: An observational study.

The occurrence of urinary retention is significantly higher in women undergoing forceps-assisted midwifery. However, the majority of these women typically regain the ability to urinate spontaneously within 72 hours after delivery. Instances of persistent urinary retention beyond this timeframe are relatively uncommon and have been rarely documented. This study aimed to investigate the risk factors associated with the persistence of urinary retention after forceps-assisted midwifery. A retrospective analysis was conducted on women who underwent forceps-assisted deliveries at the Obstetrics and Gynecology Hospital of Fudan University (China) between August 1, 2019 and December 1, 2019. The study involved collecting general clinical information of these women. Based on the duration of ureter retention, women who had a retention time >72 hours were categorized into group A, while those with a retention time <72 hours were allocated to group B. After performing analysis on the risk factors of persistent urinary retention following forceps delivery, the t test was utilized for analyzing single factors, while logistic regression analysis was employed for assessing multiple factors. Univariate analysis revealed a significant difference in the duration of the second stage of labor between group A and group B. However, logistic regression analysis did not indicate any significant difference between the 2 groups. Further research is still required to determine whether the association between persistent urinary retention following forceps delivery and prolonged second stage of labor is significant, considering the limited number of cases available for analysis.

HAEMORRHOIDECTOMY : ULTRASONIC SCALPEL VERSUS DIATHERMY CAUTERY

INTRODUCTION Haemorrhoids are the most common anorectal disease seen in age group between 45-50 years. Milligan Morgan haemorrhoidectomy is the gold standard operative procedure for grade 3 and grade 4 haemorrhoids.In the last decade high frequency sound wave energy ultrasonic scalpel is used to cut and coagulate tissues in Milligan-Morgan haemorrhoidectomy. OBJECTIVE Our aim is to do a comparative study between the outcomes of a Milligan Morgan haemorrhoidectomy by using ultrasonic scalpel versus diathermy cautery. MATERIALS AND METHODS This is a prospective comparative randomized study done over a period of 6months (April 2022-September 2022) at GGH Vijayawada. 60 patients of age group 45-65 years. They were randomly divided into 2 groups of 30 each. Group A – Underwent haemorrhoidectomy with diathermy cautery Group B- Underwent haemorrhoidectomy with harmonic scalpel. RESULTS Patients who underwent harmonic scalpel haemorrhoidectomy have statistically signicant P value in post operative pain , post op urinary retention and anal stenosis. CONCLUSION Harmonic scalpel is better than diathermy in having relatively less post operative pain and early resumption of daily activities and less occurrence of urinary retention and anal stenosis

Comparative Study between Milligan Morgan Versus Ligasure Haemorrhoidectomy

Purpose of Study: To compare the short term outcome of Ligasure haemorrhoidectomy with Milligan Morgan technique for third and fourth degree haemorrhoids. Design of Study: The present study was a single-blind randomized controlled trial. Duration and Location of Study: This trial was conducted at Akhtar Saeed Trust Teaching Hospital, Lahore. Duration of study is 6 months June 2021 to December 2021. Patients and Methods: A total of 80 subjects suffering from 3rd or 4th degree haemorrhoids were enrolled in the study and divided into two groups using lottery method. An informed written consent was taken from all the patients. Patients in group A (LS group) underwent Ligasure haemorrhoidectomy while patients in group B (MM group) underwent Milligan Morgan haemorrhoidectomy. Mean and standard deviation was calculated for numerical variables like age, operation time and postoperative pain on VAS score. Frequency and percentage was calculated categorical variables like gender, disease severity, bleeding, occurrence of urinary retention, anal stenosis and necrosis. SPSS version 22.0 was used for data analysis. Results of the Study: The patients had a mean age of 41.54±6.380 years within age range of 35-62 years. Number of male participants was high as 49 (61.3%) while compared with females who were 31 (38.7%) in total study sample of 80 subjects with a male to female ratio of 1.58:1. Number of patients with 3rd degree haemorrhoids was 53 (66.3%) whereas 27 (33.8%) patients had 4th degree haemorrhoids. LS was found to have significantly less operation time as 15.03±1.928 vs. 20.40±2.228 minutes; p-value=0.000. Postoperative pain was significantly less in LS group than MM group (4.20±0.883 vs. 5.23±0.891; p-value=0.000). Frequency of postoperative bleeding was also significantly less in LS group than MM group (5.0% vs. 25.0%; p-value=0.013). Occurrence of urinary retention was high in the LS group but the difference was not significant (p=0.247). Frequency of anal stenosis and necrosis was also less in LS group than MM group but the difference was not statistically significant with p-value=0.077 and 0.500, respectively. Conclusion: Ligasure haemorrhoidectomy was found superior to Milligan Morgan hemorrhoidectomy in managing patients with third and fourth degree haemorrhoids because it has considerably less operation time, postoperative pain and bleeding. Thus, Ligasure haemorrhoidectomy should be favored in the treatment of such cases in future surgical practice on the basis of benefits of Ligasure haemorrhoidectomy. Keywords: Hemorrhoids, Ligasure Haemorrhoidectomy, Milligan Morgan Hemorrhoidectomy

Quality of recovery after intrathecal morphine for elective Caesarean deliveries

Background: Recent supply issues with diamorphine have meant a change in practice to use of intrathecal morphine. The Obstetric Anaesthetists’ Association (OAA)1 guidelines state that intrathecal diamorphine or morphine provides adequate analgesia after Caesarean section. They discourage the use of parenteral opioids in women who have received neuraxial opioids, owing to the increased risk of respiratory depression. Other side-effects such as nausea and vomiting and pruritus may differ in severity for each drug. We reviewed the side-effects and adherence to the enhanced recovery pathway in elective deliveries receiving intrathecal morphine. Methods: Prospective data were collected for 50 women undergoing Caesarean section with intrathecal opioid analgesia (fentanyl 15 μg and morphine 100 μg) within a 5-week period. Data were collected at Day 1 and Day 2 postoperatively. These included: pain score, postoperative nausea and vomiting (PONV), pruritus, oral opioid use, anti-emetic use, chlorphenamine use, time spent in recovery, and occurrence of urinary retention. Pain score, nausea and vomiting, and pruritus were recorded using a verbal rating scale (VRS). Results: The majority (56.5%) of patients reported only mild pain, 37% reported moderate to severe pain, but of these most (94.7%) only required 20–40 mg of oral morphine in addition to simple analgesia. In addition, the majority (58.7%) of patients reported no PONV. Meanwhile, 45.7% of patients reported mild pruritus, and 43.5% reported no pruritus. Only three of the 50 women did not follow the enhanced recovery pathway. Two remained as inpatients for monitoring after obstetric haemorrhage, and one for intravenous antibiotics. There was no reported respiratory depression. Time spent in recovery was between 1 and 4 h. Although the reason for prolonged recovery stay was not audited, it was thought that requirement for oxytocin infusion increased recovery stay as the ward did not accept patients on an infusion. Conclusions: Our results show an acceptable side-effect profile after elective Caesarean delivery using intrathecal morphine, with adherence to the current enhanced recovery pathway. We aim to implement updated Caesarean delivery guidelines which include prescription of regular ondansetron and chlorphenamine as required, in conjunction with patient education, to try and reduce the incidence of bothersome PONV and pruritus. 1. Obstetric Anaesthetists’ Association, OAA commentary on alternatives to intrathecal and epidural diamorphine for caesarean section analgesia, 2018. Available from: https://www.oaa-anaes.ac.uk/ui/content/content.aspx?ID=4717

Effect of Comprehensive Care Based on Appropriate Chinese Medicine Techniques on Urinary Retention and Bladder Function Recovery after Total Hysterectomy in Patients with Cervical Cancer.

Objective To investigate the effect of comprehensive care based on appropriate Chinese medicine techniques on urinary retention and bladder function recovery after total hysterectomy in patients with cervical cancer. Methods A total of 148 cases admitted after radical hysterectomy for cervical cancer from January 2019 to early September 2019 were used as the observation sample and were divided into control and experimental groups based on a randomized double-blind method. There were 74 cases each. The control group was given comprehensive care, and the experimental group was given comprehensive care based on appropriate Chinese medicine techniques. The intervention period was 2 weeks after surgery. The recovery rate of bladder function and the occurrence of urinary retention were compared between the two groups, and the duration of postoperative retention of urinary catheter, the amount of residual urine, and the feeling of urination were counted. Results The experimental group had better urinary catheter retention time, time to first spontaneous voiding, time to get out of bed, and time to anal discharge than the control group; the experimental group had a higher rate of good bladder function recovery than the control group and better bladder recovery time, residual urine volume, and incidence of urinary retention than the control group; the patients in the experimental group had better UDI-6 scores. Conclusion The implementation of comprehensive care based on appropriate Chinese medicine techniques can relieve patients' difficulty in urination and improve their quality of life.

Comparison of two different methods of establishment of canine urethroplasty model: an experimental trial

BackgroundGraft substitute urethroplasty is recommended for patients with long segment anterior urethral stricture. The therapeutic effects of the grafts need to be validated on the animal models. Therefore the aim of this study was to compared the operative time, blood loss, intra- and post- operative complications of two different methods of establishment of canine urethroplasty model.MethodsTwelve Beagle dogs were randomly separated into control and experimental group using a random number table. Six animals in the control group received the conventional urethroplasty, while the other 6 in the experimental group received the modified procedures. Tube cystostomy and urethroplasty were performed in the control group. The cystostomy not the tube cystostomy were performed in the experimental group, and the testes were simultaneously removed with the scrotum. Per- and postoperative outcomes, complications were evaluated.ResultsThe urethroplasty were successfully performed for all dogs and all of these procedures were done by the same surgeon. The median operative time in the control and experimental groups was 186.8 min and 188.7 min respectively. The blood loss in the control and experimental groups was 40.8 ml and 45.8 ml respectively. No intraoperative complications occurred. 3 animals in the control group developed acute urinary retention after the accidental removal of suprapubic bladder tube and the cystostomy was done again. There was no occurrence of urinary retention in the experimental group. 4 animals in the control group developed the perineal hematoma, in which one animal had the urine leakage and incision infection. Perineal hematoma occurred in only one animal in the experimental group.ConclusionThe occurrence of urinary retention and perineal hematoma decreased in the modified group, in which the cystostomy not the tube cystostomy were performed and the testes with the scrotum were simultaneously removed.

Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined.

Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07-1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

Construction and application of cluster nursing measures for urinary retention after gynecological tumor radical operation

Objective To develop cluster nursing measures for urinary retention after gynecological tumor radical operation, and explore the prevention methods of urinary retention after gynecological tumor radical operation. Methods We established a gynecological rehabilitation nursing team, retrieved domestic and foreign literature, conducted a Meta-analysis on the key measures to effectively treat urinary retention, and designed and developed a set of cluster nursing measures for urinary retention after radical gynecological tumor surgery. A controlled trail was conducted in this study. Totally 54 patients treated in the gynecological ward of the First Affiliated Hospital of Shenzhen University from January 2016 to June 2017 were selected as the control group, while another 52 patients treated from July 2017 to August 2018 were selected as the experimental group. Patients in the control group received routine gynecological nursing, while patients in the experimental group received cluster nursing based on routine nursing. Data were collected using an observation record form, which included observations of patients' practice and limb mobility effects. The execution time and frequency of urinary interruption training, pelvic floor muscle function training, ankle pump exercise and thoraco-abdominal gymnastics, and the reasons for not using them, drinking test at extubation and intermittent clean self catheterization (CISC) . Data were processed and analyzed using SPSS 21.0. Results One out of the 52 patients in the experimental group had urinary retention, accounting for an incidence rate of 1.92%, delayed extubation occurred in 2 cases, with a total complication rate of 5.77% (3/52) ; while 5 out of the 54 patients in the control group had urinary retention, accounting for an incidence rate of 9.26%, delayed extubation occurred in 6 cases, with a total complication rate of 20.37% (11/54) . There was a statistically significant difference in the incidence of complications between the two groups (P<0.05) . Conclusions The cluster nursing measures are a combination of multiple effective measures, and the clinical application results have shown that they can effective prevent the occurrence of urinary retention after gynecological tumor radical surgery. Key words: Gynecological oncology; Urinary retention; Cluster nursing; Meta-analysis

Effects of modified ureteral catheter removal on urinary retention and urinary tract pain after radical resection of cervical cancer

Objective To explore the effects of modified ureteral catheter removal on urinary retention and urinary tract pain after radical resection of cervical cancer. Methods Patients undergoing radical resection of cervical cancer in a ClassⅢ Grade A hospital in Beijing from February to September 2018 were selected using convenient sampling and divided into the control group (n=52) and the intervention group (n=52) according to the random number table. Patients in the control group received routine catheter removal, while patients in the intervention group received modified catheter removal. The diagnostic criteria for urinary retention in the International Association of Urinary Control Guidelines and Wong-Bake Facial Expression Pain Rating Scale were used to evaluate the incidence of urinary retention after extubation and the degree of urinary tract pain during urination. Results The incidence of urinary retention in the intervention group was 15.4% (8/52) , which were lower than that 32.7% (17/52) in the control group, the difference was statistically significant (P<0.05) ; and Wong-Baker score in the intervention group was (2.38±1.37) , which were lower than that (4.08±1.25) in the control group, and the difference was statistically significant (P<0.05) . Conclusions The modified ureteral catheter removal can prevent the occurrence of urinary retention in patients with cervical cancer after surgery and reduce the pain during urination. Key words: Urinary retention; Cervical neoplasms; Radical resection of cervical neoplasms; Ureteral catheter removal

What's New in Bipolar TURP for Surgical Management of BPH?

Transurethral resection of the prostate (TURP) is still considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), but new methods like bipolar TURP became a real treatment alternative. Bipolar resection presents many option for the effective resection of the prostate: the most similar with m-TURP is represented by the loop resection, then transurethral vaporisation of the prostate (B-TUVP) which is derived from plasmakinetic B-TURP and the enucleation, which is among open prosta tectomy or holmium laser, the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe LUTS. There was no statistical difference observed between M-TURP and B-TURP in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement (Qmax), occurrence of urinary retention, and IPSS and quality of life (QoL) scores. On the other hand, B-TURP proved to be superior to M-TURP in relation to hospitalization time, blood transfusion rate, post-TURP syndrome, serum sodium rate and lower occurrence of urethral stenosis. when is about the cost of the procedure, a meta-analysis on 24 from the most relevant publications in the last 20 years, revealed that the TURis system demon strates equivalent efficacy versus MTURP, In conclusion, it could be observed nowadays that bipolar-TURP represents a viable alternative to M-TURP in patients with moderate to-severe LUTS secondary to BPO, with similar efficacy but lower peri-operative morbidity.

Influencing factors for postoperative urinary retention in patients with spinal surgery

Objective To investigate the influencing factors for postoperative urinary retention in patients with spinal surgery. Methods The clinical data of patients with spinal surgery were collected and divided into two groups according to the occurrence of urinary retention (urinary retention group and non occurring urinary retention group). The factors that may affect postoperative urinary retention were compared and multiple factor Logistic regression was used. Results Among the 292 patients, 56 cases had postoperative urinary retention and the morbidity was 19.18%. Single factor analysis indicated that Univariate analysis showed that there was a statistically significant difference in anesthetic mode, time of indwelling catheter, time of lying in bed, clamping catheter and timing of removal of urinary catheter (χ2=5.035-22.747, P<0.05 or <0.01). Multivariate Logistic regression analysis showed that the risk factors for urinary retention were time of catheter more than 3 days and bed time is no less than 5 days, and the protective factors were clamping the catheter indwelling training, having a sense of urine and bladder filling. Conclusions During the period of indwelling catheter can be closed catheter training, grasp the time of indwelling catheter 1-2 d best catheter time. Urinary catheter should be removed when urine is filled and bladder is filled. At the same time, under the premise of ensuring safety, the patient's bed time should be shortened as far as 5 days, and the rate of urinary retention can be reduced. Key words: Spinal surgery; Postoperative urinary retention; Influencing factors

The different timing of removing indwelling urinary catheter for puerperas who use patient controlled analgesia after cesarean section: a meta-analysis

Objective To assess the effects of removing indwelling urinary catheter at different timing on urinary retention puerper as who use patient controlled analgesia(PCA)after cesarean section. Methods Taking the database of PubMed, Embase, Cochrane Library, Medline, CNKI, CBM, VIP and Wanfang before December 2016 as the retrieval sources; collecting the results of randomized controlled trial(RCT) about the incidence of postpartum urinary retention with PCA which removing the ureteral catheter after 24 hours, 36 hours, and 48 hours respectively; using RevMan 5.3 software for statistical analysis. Results A total of 10 study papers were collected, included involving 1 639 maternity patients. The incidence of urinary retention with ureteral catheter removal after 24 hours was higher than after 36 hours, the difference was statistically significant (RR=4.95, 95%CI 3.67-6.68, P<0.01); the incidence of urinary retention with ureteral catheter removal after 36 hours was higher than after 48 hours, the difference was statistically significant (RR=3.00, 95%CI 1.66-5.41, P<0.01); the incidence of urinary retention with ureteral catheter removal after 24 hours was higher than after 48 hours the difference was statistically significant (RR=11.84, 95%CI 7.84-18.66, P<0.01). Conclusion In order to prevent the occurrence of urinary retention, the more appropriate timing to remove the urinary catheter after cesarean section with PCA is after 48 hours Key words: Cesarean section; Analgesia, patient-controlled; Urinary catheters; Urinary retention; Meta-analysis

RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material &amp; methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p&gt;0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p&gt;0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p&gt;0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.

Incidence of postoperative urinary retention after pelvic organ prolapse surgery in Cipto Mangunkusumo National General Hospital

Background: After vaginal delivery, every woman has 50% risk for pelvic organ prolapse (POP). The lifetime risk for a woman to undergo surgical treatment for POP was 11%, with the incidence of postoperative urinary retention (POUR) after POP surgery of 2%-43%. The aim of our study is to identify the incidence of POUR after POP surgery in Cipto Mangunkusumo National General Hospital (RSCM) and the risk factors.Methods: Medical records of 124 women undergoing pelvic prolapse surgery between 2010 and 2013 were analyzed. The incidence of POUR and the risk factors were identified by performing univariate and bivariate analysis using chi-Square test and its alternative with using SPSS 20.0. Independent variables include age, body mass index (BMI), parity, degree of prolapse, type of surgery technique, type of anesthesia, type of suture material, amount of intra-operative blood loss, and duration of surgery. POUR defined as urine residual volume more than 100cc.Results: The incidence of urinary retention after pelvic prolapse surgery was 29%. There was no correlation between age, BMI, parity, degree of prolapse, type of surgery technique, anesthesia, suture, intra-operative blood loss, duration of surgery, and the occurrence of urinary retention after pelvic organ prolapse surgery.Conclusion: The incidence of urinary retention after pelvic organ prolapse surgery was 29%. There was no correlation between the risk factors and the occurrence of urinary retention after pelvic organ prolapse surgery.

Pleated colposuspension: Our modification of Burch colposuspension

Introduction:Burch colposuspension is a standard treatment for stress urinary incontinence. However, it is associated with recurrence and urinary retention. We describe a modification of this technique to overcome these problems and evaluate the results in comparison with the standard procedure.Materials and Methods:A total of 145 patients with isolated stress urinary incontinence (SUI), underwent either our modified pleated colposuspension (PC); n = 97) or standard Burch colposuspension (BC) (n = 48). Description of PC: Three No. 0 non-absorbable sutures were placed in the side-to-side manner at the mid-urethral level with 0.5-1.0 cm distance between them using double bites and were passed through the Cooper's ligament. The patients were followed-up every 6 months for SUI and genital prolapse evaluation. Successful surgery was defined as (1) No self-reported SUI symptoms, (2) Negative Marshall's coughing test (MT), (3) No retreatment for SUI, (4) Absence of urodynamic SUI. In addition, failure was defined as the occurrence of urinary retention, use of catheter on 6-week visit, maximum flow rate >15 ml/s, flow time <60 s, or residual urine <100 ml. Data was compared using Student's paired test and Mantel-Haenzel's χ2 test. P > 0.05 was considered significant.Results:The mean follow-up after surgery for PC was 102.4 months and for BC was 103.6 months. At last follow-up, data suggesting failure (Stress score ≥7, urge score ≥7, Pad test with weight < 15 g/day and positive MT during lithotomic/upright position) were more frequent in BC group (P > 0.05; P > 0.0; P > 0.01; P > 0.05; P > 0.05, respectively). The incidence of recurrent SUI was 5.2% after PC and almost triple (14.6%) after BC. Residual urine <100 ml and weak stream were more frequent in the BC group (P > 0.05; P > 0.01, respectively). Detrusor over-activity on urodynamic studies, Flow time <60 s, urethral pressure profilometry positive for obstruction had a higher incidence in BC group (P > 0.01; P > 0.001; P > 0.01, respectively).Conclusion:Our modified pleated colposuspension showed improved outcomes when compared with standard Burch colposuspension.

Prevalence and outcome of urinary retention after laparoscopic surgery for severe endometriosis—does histology provide answers?

Urinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention. We evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques. The prevalence of urinary retention was 4.6% (n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01). In older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling.

Incidence of Urinary Retention Necessitating Maneuvers in Patients with Indwelling Foley Catheter for Seven Days or Less Among Patients at the Medical Intensive Care Unit

Urinary retention is the inability to empty the bladder. It may be acute or chronic. Acute urinary retention is a medical emergency requiring prompt action such as insertion of a urethral catheter. The objective of this study is to determine the incidence of bladder retention necessitating maneuvers that will induce urination in patients with indwelling foley catheter for seven days or less in an intensive care unit setting. There were a total of 125 patients who were included and observed in this study. The primary inclusion criterion was seven days on indwelling catheter. Nine out of 125 patients or 7.2% experienced urinary retention. There was a significant association noted between age and urinary retention but no association noted between sex and urinary retention. There was a significant difference in the number of days with catheter on subjects with or without urinary retention. The study showed that out of 125 patients who were included in this study, only nine patients (7.2%) had urinary retention. The predictive factors for the occurrence of urinary retention in catheterized patients include: ages of > 80 y/o and > 4 days on indwelling catheter. The gender as well as the primary illness has no association with the occurrence of urinary retention.

Relationship between doses of epidural morphine for analgesia and postoperative urinary retention

Objective To investigate the relationship between the doses of epidural morphine administered for postoperative analgesia and postoperative urinary retention (POUR). Methods Sixty ASA Ⅰ patients aged < 20-56 yr undergoing atthroscopic knee operation under epidural anesthesia were randomly divided into 3 groups ( n = 20 each) : group Ⅰ and Ⅱ received epidural morphine 1 and 3 mg in 5 ml of normal saline (NS) respectively at the end of operation (group M1, M2 ); group Ⅲ received NS 5 ml instead of morphine (group C). Urinary retention was defined as the patient could not void, when bladder volume was ≥ 600 ml measured using ultrasound. Bladder urine volume was measured before anesthesia and at 4, 6, 8, 10 and 12 h after operation. The occurrence of urinary retention, the first postoperative voiding time, VAS scores and the incidences of vomiting and pruritus were recorded. Results The 3 groups were comparable with respect to age, M/F sex ratio, preoperative bladder urine volume, the amount of local anesthetic used during operation and duration. The incidences of urinary retention, vomiting and pruritus were 65%, 60% and 90% respectively in group M2 and significantly higher than those in the other 2 groups. The first postoperative voiding time was significantly longer in group M2 than in the other 2 groups. VAS scores were significantly lower in group M1 and M2 than in group C. There was no significant difference in VAS scores between group M1 and M2. Conclusion Epidural morphine increases the incidence of POUR in a dose-dependent manner, and 1 mg is the recommended dose. Key words: Morphine; Analgesia, epidural; Urinary retention