Die postpartale Harnretention – klinisch bedeutungslos?

Abstract

Postpartum urinary retention (PUR) continues to be a not very well understood clinical condition. The incidence varies in literature between 0.05 to 14.1%, after vaginal delivery, and between 3.3 to 24.1% after cesarean section, depending on the criteria used and reflecting differences in obstetrical practice. A commonly used definition is the lack of spontaneous micturition 6 hours after vaginal delivery or after removing an indwelling catheter. After helping measures, bladder drainage, which can be done in different ways is most important in the treatment. Though it is a distressing condition, prognosis is normally good, and there are only few published data on long-term sequelae. But overstretching the bladder wall during pregnancy or delivery can result in severe detrusor damage, followed by voiding dysfunction. There are different independent risk factors such as prolonged first and second stage of labor, isolated length of the second stage, forceps delivery or vaccum extraction, perineal laceration and nulliparity. Epidural analgesia may also increase the risk of PUR, but is controversially discussed in literature. The lack of guidelines is one of the major problems in treating women with PUR.

Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

“…In contrast to postoperative management in gynecological surgery, routine measurement of the PVR is not established in obstetrics [ 1 , 23 ], and the lack of guidelines is one of the major problems in treating women with PUR [ 1 , 48 , 49 ]. Systematic sonographic monitoring of all postpartum patients at least until day 3 [ 15 , 49 ] and for 24 h after epidural analgesia [ 7 ] has been recommended to avoid excessive urinary retention.…”

“…The idea of PUR being transient and self-limiting [ 1 ] has to be questioned. This belief might explain why postpartum urinary retention management guidelines are not yet established [ 1 ] but urgently needed in clinical practice [ 48 ]. Data on PUR management are insufficient, particularly because treatment options differ widely between studies.…”

“…Protocols of timed voiding and routine measurement of PVR have been shown to reduce PUR [ 10 , 13 , 56 ]. Even if routine screening is not yet recommended [ 1 ], adequate symptom assessment by the health care provider after delivery is of utmost importance [ 23 , 48 , 57 ]. Last but not least, knowledge of PUR is considered to be low amongst residents in obstetrics and gynecology and management guidelines increase their comfort in dealing with patients in the postpartum period [ 58 ].…”

Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery

“…11 However, the routine measurement of postpartum urinary retention has not been established in obstetrics, 11,12 and the lack of guidelines is one of the major problems in treating individuals with postpartum urinary retention. 11,13,14 As a result, we chose postpartum urinary retention as the primary outcome in the present trial, which may provide evidence for clinical practice and future guidelines. Any misdiagnosis or delay in the diagnosis of postpartum urinary retention can cause bladder overdistension, leading to irreversible detrusor damage.…”

“…As a common complication in women during the immediate postpartum period, the prevalence of postpartum urinary retention ranges from 1.5% to 45% according to varying diagnostic criteria . However, the routine measurement of postpartum urinary retention has not been established in obstetrics, and the lack of guidelines is one of the major problems in treating individuals with postpartum urinary retention . As a result, we chose postpartum urinary retention as the primary outcome in the present trial, which may provide evidence for clinical practice and future guidelines.…”