Chronic urinary retention

74 years old female Known case of HTN,T2DM and Primary Hypothyroidism recently diagnosed with Chronic urinary retention. (Significant PVRU 1250ml). Urologist was consulted. Patient was catheterised and gradual decompression of urinary bladder was done @ 150ml /hour. Tab Veltam 0.4 mg once daily and Tab Urotone DS twice daily was started. Pt was kept on Foley's catheter for 2 weeks.

After 2 weeks Urologist advised to remove catheter and do clean intermittent catheterisation. But as the patient was unable to do CIC, Foley's catheter was continued for 2 months.

Now after 2 months voiding trial was given and USG was done 2 days post catheter removal which shows a Post void residual urine volume of 157ml.

Query

Is 157 ml of PVRU acceptable or patient still needs catheterisation?

The issue

Radical hysterectomy with pelvic lymphadenectomy (removal of the uterus (womb) with its surrounding tissues and lymph glands in the pelvis) is the treatment for early‐stage cervical cancer (when cancer is still within the cervix and upper vagina, without spread into nearby tissues). Bladder dysfunction (problems with the way the bladder holds and releases urine) is a common problem following radical hysterectomy, caused by the damage to the nerves controlling urination.

The aim of the review

To assess the usefulness and safety of treatment to prevent bladder dysfunction following radical hysterectomy in women with early‐stage cervical cancer. We searched the scientific databases for randomised controlled trials (studies in which people or groups of people are allocated by chance to two or more groups, treating them differently) published to April 2020.

Main findings

We found four studies that met the inclusion criteria. One study compared a medication called bethanechol to placebo (a substance that has no therapeutic effect, used as a control in testing drugs). Three studies compared suprapubic catheterisation (insertion of a flexible tube (catheter) into the bladder through a cut in the lower abdomen to drain urine) with intermittent self‐catheterisation (insertion of a catheter via the urethra, into the bladder at intervals throughout the day).

Bethanechol versus placebo

Bethanecol may reduce the chance of bladder dysfunction by lowering the volume of post‐void residual urine, assessed at one month after surgery. However, the certainty of this evidence is very low and further studies have the potential to better inform this outcome.

Suprapubic catheterisation versus intermittent self‐catheterisation

There was insufficient evidence to indicate the effectiveness of suprapubic catheterisation and intermittent self‐catheterisation for preventing bladder dysfunction. Very‐low certainty evidence noted no difference between these two treatments in the risk of an unfavourable result and urinary tract infections during the first month after surgery.

Conclusions

None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post‐void residual volume of urine of 50 mL or less, or post‐void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may prevent bladder dysfunction after radical hysterectomy by lowering post‐void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self‐catheterisation) remains unproven.