--
Richard Chudacoff, MD
To take refuge with an inferior is to betray one's self.
Peter Nivio Zarlenga
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Gerald P.
Rodríguez
Sent: Saturday, April 17, 2004 5:01 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Urinary Retention Postpartum
I think one would have a problem keeping a suprapubic catheter in for that
long. In my experience they tend to get plugged up, don't drain well at
times, etc. I also like the idea of having the bladder at complete "rest"
for an extended period of time.
Would anyone think of doing a quick cysto on this lady, just to make sure
she doesn't have a bladder polyp/stone that may be the culprit?? She could
possibly also have something unusual going on with her urethra--after all
she did have a long 2nd stage and an operative delivery. BTW, Ron, what is
"CLE?"
Gerald P. Rodríguez, M.D., FACOG
Santa Fe
>----- Original Message -----
From: "Steve & Eryl Raymond" <eryl@intekom.co.za>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Saturday, April 17, 2004 2:40 PM
Subject: Re: Urinary Retention Postpartum
> I agree that you shouldn't give up, though I don't think the right way to
do it
> is with continuous drainage. I would suggest a suprapubic which she can
empty
> after each voiding so as to allow the normal filling and emptying of
bladder
> intermittently and at the same time see how the residuals improve. Four
to six
> weeks of this treatment should see a considerable improvement. At the
same time
> as saying this I can point to no RCT or EBM on this.
> Steve
>
> Gerald P. Rodríguez wrote:
>
> > "Never" is such an ugly word, Ron. Don't give up yet. I would suggest
> > trying 4 weeks of continuous Foley drainage, followed by one week of
> > Urecholine (bethanechol chloride) with the Foley still in place,
followed by
> > Urecholine at max doses and intermittent self-cath. This is an extreme
> > case, and may not work, but you have nothing to lose.
> >
> > Gerald P. Rodríguez, M.D., FACOG
> > Santa Fe
> >
>> > ----- Original Message -----
> > From: "Dr. Ainsworth" <ainsron@sbcglobal.net>
> >
> >>I saw a patient recently who was delivered by another physician, CLE,
> >>prolonged 2nd stage, VE assisted delivery. She had postpartum urinary
> >>retention, requiring a foley catheter until discharge. When the
> >>catheter was removed on the second postpartum she was sent home. 3d
> >>later she saw me for incontinence, she had a residual of >4000cc. It
> >>has now been 4wks, she is still doing intermittent self-catheterization,
> >>voiding 50-100cc, residuals of 150 to 400cc. What is her prognosis for
> >>normal voiding? Anyone have any experience with similar situations? When
> >>I discussed this with a urogynecologist, he felt she will never void
> >>normally, saying that overdistention to that degree will cause permanent
> >>damage to the small nerve endings in the bladder. Thanks. Ron
> >
>
