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Re: Urinary Retention Postpartum From: Braun, R. Daniel (rbraun@iupui.edu) Sun Apr 18 04:54:49 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ainsron: "Re: Urinary Retention Postpartum" Previous message: DoctorJoe@aol.com: "Re: Challenge" Maybe in reply to: Dr. Ainsworth: "Urinary Retention Postpartum" You use one of those fancy small supra pubic kitsthat have an 8 Fr. Catheter. If you put in a 16 Fr. Red Rubber through a Gall Bladder trochar and sew it to the skin, it will work for a long time. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----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 > > > Next message: ainsron: "Re: Urinary Retention Postpartum" Previous message: DoctorJoe@aol.com: "Re: Challenge" Maybe in reply to: Dr. Ainsworth: "Urinary Retention Postpartum"

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