Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Abstract Introduction and hypothesis Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions PBD was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function.

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Acceptable Postvoid Residual Urine Volume after Vaginal Delivery and Its Association with Various Obstetric Parameters

Obstetrics and Gynecology International ◽

10.1155/2018/5971795 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Wen Sze Choe ◽

Beng Kwang Ng ◽

Ixora Kamisan Atan ◽

Pei Shan Lim

Keyword(s):

Urinary Retention ◽

Urine Volume ◽

Active Phase ◽

Perineal Pain ◽

Residual Urine Volume ◽

Residual Urine ◽

Second Stage Of Labour ◽

Postpartum Urinary Retention ◽

Labour Epidural Analgesia ◽

Postvoid Residual Urine

Background. Urinary retention and voiding dysfunction is a distressing event and relatively common in immediate postpartum period. This study aims at investigating the range of postvoid residual urine volume after vaginal delivery and its association with various obstetric parameters. Methods. This was a prospective observational study of women who delivered vaginally in Universiti Kebangsaan Malaysia Medical Centre from March 2017 to September 2017. Those who were able to void within 6 hours after delivery, the voided volume measurements were taken at their second void followed by measurement of residual urine using a transabdominal ultrasound scan. For those unable to void at 6 hours postpartum, the bladder volume was measured. If the bladder volume was 500 ml or more, an indwelling catheter would be inserted and kept for 24 hours. Results. A total of 155 patients who fulfilled the inclusion were recruited. There were 143 (92.3%) patients who had residual urine volume of less than 150 ml at second void. Out of these 143 patients, 138 (96.5%) had residual urine volume of less than 100 ml, and among the 138 patients, 119 (86.2%) had residual urine volume of less than 50 ml. The median residual urine volume was 10 ml (2, 42). The overall rate of postpartum urinary retention (PPUR) was 7.7%; 6 (3.85%) had overt retention and 6 (3.85%) had covert retention. Primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and perineal pain score were independent risk factors associated with postpartum urinary retention. Conclusion. Postpartum urinary retention complicates approximately 7.7% of vaginal deliveries. Majority (86.2%) of them had residual urine volume less than 50 ml. Obstetrics factors independently associated with PPUR include primiparity, duration of active phase of labour, duration of second stage of labour, epidural analgesia, episiotomy, instrumental delivery, and degree of perineal pain.

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Can Urinary Catheterization Before Birth Reduce Postpartum Urinary Retention?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.89 ◽

2016 ◽

Vol 22 (1) ◽

Author(s):

Mehmet B. Şentürk ◽

Hakan Güraslan ◽

Ender Güven ◽

Yusuf Çakmak ◽

Mehmet Şükrü Budak

Keyword(s):

Urinary Retention ◽

Randomized Study ◽

Urine Volume ◽

Urinary Catheterization ◽

Residual Urine Volume ◽

Chi Square ◽

Residual Urine ◽

Postpartum Urinary Retention ◽

Chi Square Test ◽

Micturition Problems

Objective: Postpartum urinary retention (PUR) is defined as no spontaneous micturition in a period of more than 6 hours postpartum or residual volume of >150cc after urination. If a diagnosis is not made, there may be problems of over-distention of the bladder and consequently, denervation, detrusor atony and long-term micturition problems. This study aimed to examine the effect of urinary catheterization during birth on postpartum urinary retention (PUR).Study Design: A prospective randomized study was conducted with 137 patients. The study and control groups were formed according to a random number table. In the study group, urinary catheterization was applied before birth. In both groups, the time of the first postpartum micturition was recorded and after the first micturition, the residual urine volume was measured with catheterization. Cases with no spontaneous micturition in the first 6 hours postpartum were accepted as PUR. The two groups were compared with respect to time of first micturition and residual urine volume using Mann Whitney U-test and the presence of PUR with Chi-square test. Results: The time to first micturition was determined to be shorter in the group where urinary catheterization was applied before birth, the PUR rate was lower and the amount of residual urine was less (p<0.05). Birthweight, duration of labour, maternal age, weight, gravida and use of oxytocin were similar between the groups (p>0.05). Conclusion: Urinary catheterization before birth reduces the rate of PUR.

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Parity and Duration of Labor Affects the Risk of Urinary Retention in post C-Section Patients

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v37i1.336 ◽

2016 ◽

Author(s):

Yulia I. Nurullah

Keyword(s):

Risk Factors ◽

Urinary Retention ◽

Transvaginal Ultrasound ◽

Urine Volume ◽

Residual Urine Volume ◽

Retention Factors ◽

Residual Urine ◽

Labor Duration ◽

The Mean

Objective: To determine the rate of urinary retention cases and contributing risk factors in Department of Obstetrics and Gynecology Dr. Mohammad Hoesin Hospital (RSMH), Palembang. Methods: The study conducted on 111 patients who met our study criteria. After CS, urinary catheter were inserted for 24 hours, and then it was opened for 6 hour, after that patients were asked to urinate spontaneously, then we examined the residual urine volume with transvaginal ultrasound. If residual urine volume post CS was >200 ml, it categorized as urinary retention. Result: During the follow up we found that the rate of urinary retention after CS was 3.6% (4 subject). All subject has a covert urinary retention. Factors contribute to post CS urinary retention was duration of labor and parity. The mean of labor duration in group with urinary retention is 8.75±13.04 hour, and 7.55±7.28 hour in the normal group (p = 0.003 RP= 106.00 CI 95%= 6.587-1705.778). All case with urinary retention were primipara (p = 0.045). Conclusion: Our study found that the rate of post CS urinary retention was 3.6%. Risk factors for post CS urinary retention were duration of labor more than 24 hours and primipara. [Indones J Obstet Gynecol 2013; 37-1: 46-50] Keyword: caesarean section, residual urine, urinary retention

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Intraprostatic Endoprosthesis

Urologia Journal ◽

10.1177/039156039205900112 ◽

1992 ◽

Vol 59 (1) ◽

pp. 53-57

Author(s):

V. De Luca ◽

E. Frego ◽

L Giambroni ◽

A. Cozzoli ◽

C. Simeone ◽

...

Keyword(s):

Urinary Retention ◽

Urine Volume ◽

Residual Urine Volume ◽

Residual Urine ◽

Stop Test ◽

Endoscopic Guidance

The indications and advantages of an intraprostatic endoprosthesis (IPEP) in the case of obstructive symptoms and urinary retention in patients with BPH are well known. The aim of this study is to report our preliminary experience in the use of a new IPEP which has been developed at our Institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopic guidance. The IPEP consists of three detachable parts, which are assembled coaxially to form an ordinary catheter. This procedure is made easier by a knob on the catheter which can be localized by inserting a finger into the rectum. The unit is compact, flexible and smooth. While positioning the IPEP, it is also possible to insert it and draw it back without causing any change to its shape. It is positioned by following the same procedure used for catheters. From November 1989 to April 1991, IPEP prototypes were inserted, with patients’ permission, in 16 patients with BPH and a residual urine volume of 150 cc (mean age 67 years; range 52 to 83 years). In all cases the procedure lasted only a few minutes. In 11 patients the prosthesis was correctly positioned, their stop test and uroflowmetry being valid. In 2 (12%) the procedure was not immediately successful and an additional catheter had to be used. In 3 (19%), it was repositioned.

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Effects of Acupuncture on Hospitalized Patients with Urinary Retention

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/2520483 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Suhui Chen ◽

Hua Sun ◽

Hong Xu ◽

Yamin Zhang ◽

Huanyuan Wang

Keyword(s):

Urinary Retention ◽

Acupuncture Treatment ◽

Urine Volume ◽

Hospitalized Patients ◽

Controlled Study ◽

Efficacy Rate ◽

Large Sample Size ◽

Residual Urine Volume ◽

Residual Urine ◽

Significant Difference

Objective. The aim of this study was to investigate the effects of acupuncture on urinary retention and provide treatment suggestions. Methods. A total of 113 hospitalized patients with urinary retention were included in this study. The GV20, CV6, CV4, CV3, ST28, SP6, and SP9 points were selected as the main acupoints. Acupuncture therapy was conducted for 30 minutes per session. The total number of treatment sessions was determined by the symptoms and the length of hospital stay. Bladder postvoid residual urine volume (PVR) was measured pretreatment and posttreatment by ultrasonic. Efficacy defined as spontaneous urination and a residual urine volume <50 mL was measured. Results. The median number of acupuncture treatment sessions was 3 (range, 1–12 times). Acupuncture treatment significantly reduced the PVR (545.1 ± 23.9 mL vs 67.4 ± 10.7 mL; p<0.001). Among the 113 patients, 99 (87.6%) patients were cured and 8 (7.1%) patients were improved of their urinary retention. The remaining 6 (5.3%) patients’ urinary retention did not improve. The effective rate was 94.7%. There was significant difference in the efficacy rate between patients with one urinary catheterization and with two or more. Acupuncture treatment was not associated with side effects. Conclusion. Acupuncture is an effective and safe treatment option for urinary retention. Early application of acupuncture treatment should be considered in clinic, and repeated urinary catheter insertion and removal should be avoided. Our study suggests that a randomized controlled study with a large sample size to verify the efficacy of acupuncture for the treatment of urinary retention is warranted.

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