High risk patients for urinary retention:
(1) hernia surgery
(2) anal surgery
(3) history of previous urine retention
Observations by authors:
(1) Routine gynecologic outpatient surgery does not increase the likelihood of urinary retention and should be viewed as low risk.
(2) Aggressive fluid administration does not alter the incidence of retention or time to voiding. It may make urinary retention more likely by overdistending the bladder.
(3) Urinary retention occurred in <= 0.5% of low risk patients
(4) Urinary retention occurred in 5% of high risk patients.
(5) Urinary retention recurred in 25% of high risk patients after discharge.
If the person is not high risk (= low risk):
(1) The person does not need to void before discharge.
(2) If the person has not voided by 8-12 hours after discharge, then he or she should return to a medical facility.
If the person is high risk and has voided:
(1) If ultrasound is readily available, then consider monitoring the residual urine volume.
(2) The patient may be discharged. If the person has not voided by 8-12 hours after discharge, then he or she should return to a medical facility
If the person is high risk, has not voided and ultrasound is available:
(1) If the person is ready for discharge, then monitor bladder volume with ultrasound.
(2) If the bladder volume is >= 600 mL, then catheterize and drain the bladder. If the bladder volume is < 600 mL, then continue to observe until either the patient voids or catheterization is required.
(3) If the person is reliable AND if the person has ready access to a medical facility, then the person may be discharged but should be cautioned to return if unable to void within a further 8 hours.
(4) If the person is unreliable OR if the person does not have ready access to a medical facility, then the person should be held in observation to see if the person can subsequently void.
(4a) If the person does subsequently void, then the person can be discharged. If the person has not voided by 8-12 hours after discharge, then he or she should return to a medical facility.
(4b) If the person has not subsequently voided, then an indwelling catheter should be placed.
If the person is high risk, has not voided and ultrasound is not available:
(1) If the person is ready for discharge, then catheterize and drain the bladder.
(2) If the person is reliable AND if the person has ready access to a medical facility, then the person may be discharged but should be cautioned to return if unable to void within a further 8 hours.
(3) If the person is unreliable OR if the person does not have ready access to a medical facility, then the person should be held in observation to see if the person can subsequently void.
(3a) If the person does subsequently void, then the person can be discharged. If the person has not voided by 8-12 hours after discharge, then he or she should return to a medical facility.
(3b) If the person has not subsequently voided, then an indwelling catheter should be placed.
