Evaluation
- Initial First Step: Bladder Scan (US)
- Differentiate Urinary Retention from Other Causes
- If Scan Unavailable, “In-and-Out” Catheterization to Both Drain & Measure Fluid in the Bladder is an Option (More Invasive)
- If Concerned for Acute Kidney Injury (AKI):
- Renal Function Panel/Basic Metabolic Panel
- Fractional Excretion of Sodium (FENa)
- Urinalysis
Postoperative Urinary Retention (POUR)
- Prevention: Early Ambulation & Limited Narcotic Use
- Catheter to Decompress if Volume > 400-600 cc on Bladder Scan (US)
- Treatment Options: Debated
- Clean Intermittent Catheterization (Straight Cath)
- Lower Risk of Bacteriuria & Infection
- Potential Risk of Long-Lasting Detrusor Decompensation with Bladder Overdistention
- Consider a “3-Strike Rule” – If Patient Fails to Void 3-Times Sequentially, Leave an Indwelling Foley Catheter
- Indwelling Foley Catheter
- Wait 1-5 Days for Repeat Voiding Attempt
- Does Not Mandate Hospitalization & Can Be Managed Outpatient
Oliguria/Anuria
- Start with a Bolus of Crystalloid Fluid – 1 Liter Lactated Ringer
- Consider Smaller Boluses (500 cc) in CHF
- Postoperative Patient May Require Multiple Fluid Boluses if Under-Resuscitated in the OR
- Ongoing Management Should Be Directed Based on the Cause