Use of an individualised maximum bladder volume in post-op patients reduces the need for catheterization compared with arbitrary 500mL threshold.

pearl

• Tammo A Brouwer, Peter F W M Rosier, Karel G M Moons, Nicolaas P A Zuithoff, Eric N van Roon, and Cor J Kalkman.
• From the Department of Anesthesiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands (T.A.B.); Department of Functional Urology, University Medical Center Utrecht, Utrecht, The Netherlands (P.F.W.M.R.); Division of Perioperative Care and Emergency Medicine, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (K.G.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (N.P.A.Z.); Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands, and Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands (E.N.v.R.); and Division of Anesthesiology, Intensive Care, and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.K.).
• Anesthesiology. 2015 Jan 1;122(1):46-54.

BackgroundUntreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient's own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization.MethodsRandomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization.ResultsThe average MBC in the control group was 582 ml (±199 ml) and in the index group 611 ml (±209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group.ConclusionsIn patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.

22 keywords...

hide…