|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: urinary obstructionFrom: ainsron (ainsron@sbcglobal.net)Tue Mar 13 08:06:48 2007
I think you have already ruled out bladder injury from the surgery, if she had intraperitoneal drainage of urine, her BUN and Creatinine wouldn't have come down so quickly after draining her bladder. She had urinary retention, probably beginning immediately postop and any spontaneous voiding she had was probably overflow. With that degree of distension of the bladder, she will probably need prolonged catheter drainage and may always have difficulty voiding. She will need bladder retraining and needs to be taught intermittent self-catheterization and use it faithfully until she gets her residuals below 100ml. Did she have intrathecal narcotics for postop pain management? Opiates have been reported to cause acute urinary retention. Did your nursing staff document that she was able to void postop before they sent her home? Here's a site for a review article: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1464-410X.2006.06009.x?co okieSet=1 And this is another reference: Michael J. Swinn1 and Clare J. Fowler1 <http://www.springerlink.com/content/406544352k634880/#ContactOfAuthor2#Cont actOfAuthor2> Contact Information (1) Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG London, UK Received: 30 August 2001 Accepted: 7 September 2001 Abstract A group of women with otherwise unexplained urinary retention occurring as an isolated phenomenon have been shown to have abnormal urethral sphincters, as assessed by electromyography, transvaginal ultrasonographic volume and pressure profile. A questionnaire survey of a number of women diagnosed with the disorder showed that there was a common natural history, and from the results it was possible to build up a profile of the "typical" patient. She is likely to be between 20 and 35 years old and also to have polycystic ovaries. Before the onset of retention she is likely to have had a relatively mild voiding dysfunction, such as infrequent voiding or an intermittent stream. Commonly her first retention episode will follow a triggering event such as an operation or childbirth. The retention is unlikely to resolve but is not associated with the development of other disorders. Neuromodulation of the sacral nerves is the only intervention that has been demonstrated to restore voiding. Key words urinary retention in young women - sphincter relaxation - Fowler's syndrome - channelopathy _____ Contact Information Clare J. Fowler Email: c.fowler@ion.ucl.ac.uk Phone: 020 7837 3611 Fax: 020 7813 4587 Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod, Darryl G Maj 48 MDOS/SGOBO Sent: Tuesday, March 13, 2007 5:05 AM To: Multiple recipients of list OB-GYN-L Subject: urinary obstruction You know I'm feeling like I'm just full of interesting cases these days, which usually would be a good thing, but now I'm getting a bit annoyed. 24 yo G1p1 with secondary infertility and pelvic pain/dysmenorrhea underwent a diagnostic laparoscopy with me a week ago. Two trocar incisions, one small peritoneal biopsy in the posterior cul-de-sac of the only thing close to resembling endometriosis (it wasn't), 20 minutes tops. Otherwise no pathology seen. Pt presented 2 days after surgery with nonspecific abdominal pain and distension. Acute abdominal series showed nonspecific bowel gas pattern. Labs including UA, CBC and metabolic panel were normal. Pt was discharged. Pt presented at postop day 6 with more distension and pain. Acute series showed an ileus. The bladder was cathed for a specimen and drained 2 (two) liters of urine. On admission patients BUN was 74 and creatinine was 7.4. After bladder drainage the creatinine was down to 1.6. The only known medical condition with this patient is currently untreated rheumatoid arthritis. She had been on methotrexate, humera (sp?) and steroids but stopped all 9 months ago. She does report a history of multiple UTIs as a child and adult, but no problems with constipation. She does have dyspareunia nearly always. Our plan so far has been foley catheter drainage for 7-10 days with prophylactic antibiotics. The urologist is going to do a cystogram today to evaluate for possible bladder injury during laparoscopy and will do a VCUG at 7-10 days to look for reflux. NPO for now until she begins to pass flatus again. Any thoughts on workup, management or differential? Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer.
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:46:13 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.