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Be aware of the risk of urinary retention following prostate surgery.

I recall vividly the patient who attended his first physical therapy appointment one day after having his catheter removed following a radical prostatectomy surgery. He appeared a bit pale and mildly sweating. I asked him if how he was feeling, and he replied that he did not feel well. No fever, aches, chills, but something just did not seem right to him. I inquired if he had in fact been able to void since his catheter was removed. "Oh yes," he replied, "I have been peeing a little all night." I then asked him to quantify how much he was voiding, and he stated that it was 1-2 Tablespoons several times in the night. Although voiding amounts decrease typically in the evening, we also find that patients who have just had radical prostatectomies leak in the evening early in recovery. He had not been leaking during the evening. I was able to immediately contact the patient's surgeon and express my concern that the patient was in urinary retention. The patient was instructed to go immediately to the emergency room and an extraordinary amount of fluid was removed from his over-distended bladder.

This is a situation that pelvic rehab therapists need to be very alert towards. It is not only post-surgical patients who can be retaining urine, however, it is a common risk following a procedure such as a prostatectomy or a TURP (transurethral resection of the prostate.) An article appearing in the Urologic Nursing Journal identifies risk factors for such retention following a TURP procedure (these may be completed to remove part of an enlarged prostate gland that is limiting voiding.) A chart audit of 156 patients revealed that 15.4% of the patients had acute urinary retention. The risk factors included prostate size, clot retention, and pre-surgical UTI (urinary tract infection) or a failed voiding trial post-surgically.

Keep in mind that if you are treating patients who have recently had a procedure such as prostate surgery, urinary retention can be an even more urgent issue than urinary leakage. Even if a patient reports that he has been voiding, it is important to ask further questions to determine amounts voided. Because of the risk of post-operative infection, anytime a patient does not look right (perhaps pale, clammy, confused) it may be important to request that the patient follow-up with a physician or other medical provider. It is also helpful to keep screening items in your office such as a thermometer with disposable sleeves, blood pressure cuff, and to use them when needed.

If you are interested in joining the Society of Urologic Nurses, or in ordering their Journal, you can access the information here. It is only $45/year to receive the journal, and the annual conference will take place in San Antonio, Texas this October.

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