OB-GYN-L Messages for April, 2004: Re: Urinary Retention Postpartum

Re: Urinary Retention Postpartum

From: ainsron

ainsron@sbcglobal.net

Sun Apr 18 18:57:28 2004

Ronald E. Ainsworth

-----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 3:01 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
> >
>

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