What are the causes and consequences of bladder overdistension?: ICI‐RS 2011

Abstract

ApBO is an important, but often unrecognized medical complication. There is a need for defining the terminology, for studies to record the incidence of different types of bladder overdistension, and to establish management strategies. Apart from clean intermittent self catheterization (CIC) there are no data justifying pharmacological or other therapies. Therefore, prevention is of paramount importance and there is a need to develop and test preventative strategies, which should then be incorporated in surgical registries.

Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty

“…The inconsistency is clearly illustrated by Balderi et al (2011) who, in a retrospective study, defined POUR as the failure to void despite a bladder volume > 500 mL (Balderi et al 2011), although a review by the same authors 1.5 years previously stated that “…catheterization is recommended at a volume ≥ 600 mL” (Balderi and Carli 2010). In summary, there are no conclusive clinical data on the definition of POUR or on the optimal interventional threshold for catheterization (Madersbacher et al 2012). …”

“…However, the use of IPSS to predict POUR in fast-track THA and TKA is rational, calling for high-quality studies in standardized settings with well-defined criteria for POUR. Also, we still need to know whether THA carries a higher risk of POUR than TKA (Balderi et al 2011, Griesdale et al 2011, Madersbacher et al 2012). …”

“…Although different pharmacological approaches have been attempted to avoid POUR, the results have been inconclusive or controversial (Baldini et al 2009), leaving indwelling or intermittent bladder catheterization as the only option for prevention and treatment of POUR. However, both POUR and catheterization may increase the risk of urinary tract infection, with subsequent risk of wound and prosthesis infection and/or renal impairment (Madersbacher et al 2012). Also, POUR and its sequelae may prevent early mobilization, which is essential in fast-track THA and TKA, and may prolong hospitalization and increase re-admission rates (Kehlet 2013).…”

General Anesthesia: To catheterize or Not? A Prospective Randomized Controlled Study of Patients Undergoing Total Knee Arthroplasty

“…Though some researchers developed different pharmacological approaches to avoiding POUR, the results seem inconclusive or controversial [2], which leaves indwelling or intermittent urinary catheterization as the only option for prevention and treatment of POUR. However, both POUR and bladder catheterization can increase the risk of urinary tract infection (UTI), which can lead to hematogenous bacteremia [3][4][5], seeding of the implant, and subsequent joint infection following total knee arthroplasty (TKA). In addition, POUR and its sequelae may prevent early mobilization, prolong the hospitalization and increase readmission rates [6].…”

Effect of high level of bladder filling on spinal nociception and motoneuronal excitability

“…Urgency is currently described as sudden, compelling desire to pass urine that is not possible to defer . Theoretically, very high bladder distension levels represent a painful and potential dangerous condition (Wyndaele and De Wachter 2002;Madersbacher et al 2012) for the bladder, leading to an increase in the A-delta and C fibers excitatory inputs onto the sacral spinal cord neurons which may suppress or lessen the descending inhibitory effects.…”