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Thursday, December 12, 2013
Why am I Having Difficulty Urinating?
I am 75 yo man. I have had surgeries for replaced knees, bladder tumors, and others, all with GA. After all the work is done and I am back home or in the hospital room I can never pee. A catheter has to be put in always. A lot of hospital and Dr. office people have told me that the anesthesia has affected my bladder muscle and it won`t squeeze the pee out. After 4-5 days when the catheter is taken out, I can pee again, but even then it takes a few days to get back to normal. Is there anything the anesthesiologist can do so my bladder will not be so affected? It is not a blockage like an enlarged prostate or anything (my urologist has confirmed that) but just the inability of the bladder to empty itself.
Thanks for your interesting question. Studies have shown that anesthesia is only one of several factors that can cause your problem, which is known as “urinary retention”. But there is a perhaps understandable tendency among some doctors to blame anesthesia for anything that goes wrong after surgery! As anesthesiologists, we are accustomed to this phenomenon and usually are able to make light of it with our surgical colleagues.
Spinal or epidural anesthesia is a well known cause of urinary retention – in these cases, the retention usually lasts only a few hours and can be remedied by emptying the bladder with a catheter during that short period of time while the anesthetic wears off. However, specific anesthetic agents used in premedication and in general anesthesia seem to have little to do with urinary retention. Similarly, analgesic (pain) medications probably have little effect.
Surgery of the pelvis or urinary tract can cause urinary retention through inhibition of bladder reflexes caused by surgical manipulation. Another factor that can prevent the bladder from emptying normally is excess fluid administration resulting in bladder distension. Pain and anxiety can also contribute to the problem. The effects of non-anesthetic medications can play a part – the medications that do this, such as anticholinergic medications, have effects on parts of the autonomic nervous system which control bladder emptying. Inability to stand or sit after surgery has been found to be a common cause of retention. In older men, enlargement of the prostate gland is a frequently leads to retention.
Unfortunately, patients who have had urinary retention, like yourself, are at particularly high risk of having this happen again. Individuals with this problem often have an abnormal voiding history before the surgery, which may indicate the presence of an “occult” (silent) neuropathic (nerve) or obstructive bladder disorder. The fact that you have previously had surgery on your bladder makes me suspect that this is case – however this is only speculation, and you should discuss this in detail with your urologist. Your urologist may be able to do special tests to determine whether there is a subtle bladder problem which is your predisposing factor for postoperative urinary retention.
Regrettably therefore, there is probably not much your anesthesiologist can do to prevent this from happening again. However, you should definitely discuss this problem with both your surgeon and your anesthesiologist before any subsequent surgery to try and address correctable factors, such as those I’ve mentioned, before, during and after the surgery.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University