scholarly journals Complications Associated with Oocyte Retrieval: An Unusual Case of Hematuria and Recurrent Urinary Retention

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Urinary Retention ◽  
Ovarian Hyperstimulation Syndrome ◽  
Acute Urinary Retention ◽  
Unusual Case ◽  
Urinary Catheter ◽  
Oocyte Retrieval ◽  
Ovarian Hyperstimulation ◽  
Management Options ◽  
Bladder Irrigation ◽  
Blood Clots

Background: Complications associated with oocyte retrieval include ovarian hyperstimulation syndrome, ovarian torsion, infection, bleeding, and even acute urinary retention. Case: A 29 year old female presented to the emergency department for dizziness and syncope following oocyte retrieval and was admitted for ovarian hyperstimulation syndrome. Her urinary catheter was obstructed by blood clots and relieved with bladder irrigated. The catheter was removed after twenty-four hours, and she was able to void spontaneously. Four days after discharge, she returned for urinary retention. She underwent cystoscopy and 10cc of blood clots was evacuated. The bladder appeared normal without intravesicular bleeding, and she was discharged home. Twelve hours later, the patient returned for urinary retention. Another cystoscopy was performed and 150cc of blood clots was evacuation. Her symptoms resolved. Conclusion: Hematuria and urinary retention are rare but serious complications of oocyte retrieval. Management options include a urinary catheter, bladder irrigation, urologic imaging, and cystoscopy

Severe ovarian hyperstimulation syndrome with GnRH agonist trigger during the COVID pandemic: lessons learned from an unusual case

2021 ◽  
Vol 5 (04) ◽  
pp. 01-04
Author(s):  
Bradley S Hurst ◽  
Evan Schrader ◽  
Tanner Hurley ◽  
Lariena Welch ◽  
Ying Ying ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Unusual Case ◽  
Oocyte Retrieval ◽  
Lessons Learned ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Agonist Trigger ◽  
Severe Ohss

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

scholarly journals Prevention of Ovarian Hyperstimulation Syndrome: A Review

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Vinayak Smith ◽  
Tiki Osianlis ◽  
Beverley Vollenhoven
Keyword(s):  
Gnrh Agonist ◽  
Ovulation Induction ◽  
Ovarian Hyperstimulation Syndrome ◽  
Best Practice ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Hyperstimulation ◽  
Management Options ◽  
Broad Perspective ◽  
Single Method

The following review aims to examine the available evidence to guide best practice in preventing ovarian hyperstimulation syndrome (OHSS). As it stands, there is no single method to completely prevent OHSS. There seems to be a benefit, however, in categorizing women based on their risk of OHSS and individualizing treatments to curtail their chances of developing the syndrome. At present, both Anti-Müllerian Hormone and the antral follicle count seem to be promising in this regard. Both available and upcoming therapies are also reviewed to give a broad perspective to clinicians with regard to management options. At present, we recommend the use of a “step-up” regimen for ovulation induction, adjunct metformin utilization, utilizing a GnRH agonist as an ovulation trigger, and cabergoline usage. A summary of recommendations is also made available for ease of clinical application. In addition, areas for potential research are also identified where relevant.

scholarly journals A simple and effective method for bladder blood clot evacuation using hydrogen peroxide

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092454
Author(s):  
Ming Xu ◽  
Lu Jin ◽  
Yuxi Shan ◽  
Jin Zhu ◽  
Boxin Xue
Keyword(s):  
Hydrogen Peroxide ◽  
Urinary Retention ◽  
Blood Clot ◽  
Foley Catheter ◽  
Large Diameter ◽  
Emergency Evacuation ◽  
Hydrogen Peroxide Solution ◽  
Bladder Irrigation ◽  
Blood Clots ◽  
Clot Evacuation

Objective Urinary retention caused by bladder clots can be frustrating because such blood clots are difficult to remove. We established a novel technique in which hydrogen peroxide is applied to evacuate bladder clots. Methods In this single-center retrospective study, we evaluated 31 patients with retention of blood clots in the bladder who underwent emergency evacuation using hydrogen peroxide. Results The patients comprised 17 men and 14 women with mean age of 61.2 years (range, 42–82 years). Hydrogen peroxide solution and a 20-Fr three-cavity Foley catheter with large-diameter side holes were used for manual bladder irrigation in all patients. The bladder blood clots were successfully removed in 27 patients. The remaining four patients could not tolerate the symptoms of urinary retention and had to resort to surgery. Conclusion Hydrogen peroxide solution for manual bladder irrigation can improve the efficiency of bladder blood clot evacuation. This is a simple and effective option for managing bladder clot retention.

Acute Urinary Retention: How Useful is an Ambulatory Care Protocol?

2009 ◽  
Vol 16 (3) ◽  
pp. 134-140 ◽  
Author(s):  
YK Li ◽  
CS Leung ◽  
TL Hui ◽  
LH Chiu
Keyword(s):  
Ambulatory Care ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Urinary Catheter ◽  
Retention Volume ◽  
Binary Logistic Regression ◽  
Urine Retention ◽  
Care Protocol ◽  
Successful Weaning ◽  
Male Patients

Introduction Acute urinary retention (AUR) is a common urological presentation to emergency departments (ED). An ambulatory care protocol had been developed allowing trial without catheterization (TWOC) instead of admission to hospital after catheterization in the ED. This study aimed to evaluate the efficacy of the ambulatory care protocol for patients with AUR. The secondary aim was to identify any independent predictor(s) for successful weaning of urinary catheter in a short duration. Methods This was a prospective cohort study. A total of 143 male patients presenting with an episode of AUR underwent urinary catheterization once. Those who were unable to pass urine afterwards were catheterized again and discharged home with a urinary catheter in-situ (Day 0). On Day 3, ability of spontaneous urination was assessed. If failed, spontaneous urination was assessed again on Day 6. Results Successful TWOC was recorded in 50.3% of the 143 patients after first catheterization. The cumulative successful rates for first (Day 3) and second (Day 6) follow-ups were 76.9% and 79.0%, respectively. Among the associated predictors, only the urine retention volume on first catheterization was found to be independently associated with successful TWOC, using binary logistic regression (p=0.001). Conclusion The ambulatory care protocol was successful in weaning off urinary catheter for 50.3% of patients with AUR after first catheterization and a further 26.6% on Day 3, making a cumulative success rate of 76.9%. Those who failed TWOC on Day 3 would get little benefit on further trials. The first catheterization volume was independently associated with the chance of successful TWOC.

scholarly journals Aseptic Meningitis with Urinary Retention: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Fotinie Ntziora ◽  
Aristidis Alevizopoulos ◽  
Kostas Konstantopoulos ◽  
Sofia Kanellopoulou ◽  
Dimitrios Bougas ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Aseptic Meningitis ◽  
Acute Urinary Retention ◽  
Urinary Catheter ◽  
Viral Pathogens ◽  
Meningeal Irritation ◽  
Case Presentation ◽  
The Third ◽  
Bladder Sensation ◽  
Mild Headache

Introduction. Aseptic meningitis is serious inflammation of the meninges caused by agents including viruses, non-viral pathogens, non-infectious conditions and chemicals.Case Presentation. This study concerns the case of a 16-year-old healthy Greek female with persistent fever, mild headache and acute urinary retention, secondary to aseptic meningitis. Physical examination revealed no distinct signs of meningeal irritation. The urinary bladder was palpable, painless and over-distended. Serology carried out for common viruses was as follows: CMV IgG (−), CMV IgM (−), HSV IgG (−), HSV IgM (+), VZ IgG (+), VZ IgM (−), EBV IgG (−) and EBV IgM (+). During recovery in hospital, three trials of removing a urinary catheter were carried out; during the first two attempts the patient was unable to urinate and had a loss of bladder sensation. On the third attempt the patient had modest bladder perception but she left a post-voiding residual, and was instructed to perform bladder self-catheterization. Seven days after being discharged the patient underwent a full recovery.Conclusion. There are few reports concerning aseptic meningitis together with acute urinary retention. A number of these cases concern so-called “meningitis-retention syndrome,” which implies an underlying CNS mechanism, while others concerned an underlying peripheral nervous system mechanism.

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