Anaesthetic and urinary retention especially with bph

[William Bryant]

Which anaesthetic is least likely to cause post operative urinary retention? Is it local that is least likely with general carrying a greater risk of POUR and hence the need for a catheter?

Is this still true for those with prostate enlargement?

Mine prostate is “slightly” enlarged and I urinate very frequently. I don’t take medical but am thinking when I have surgery it may be prudent to start alfuzosin some time prior.

Is alfuzosin better than flomax? Or about same seeing as both are alpha blockers?

[David M]

Hi William,

I have no idea about the about the answer with this, but had to remark at the irony of the acronym for post operative urinary retention being… POUR!

[William Bryant]

I know! I thought that too. Most inappropriate. I think there are others too in a similar manner that don’t match what they describe.

[Good intentions]

It’s a hot topic. Here’s a recent paper that suggests that there are many causes.

https://www.ncbi.nlm.nih.gov/books/NBK549844/

Postoperative Urinary Retention
AJ Pomajzl; Larry E. Siref.

“…
Anesthesia can pharmacologically impact normal micturition. General, spinal, and regional anesthetics can all lead to POUR by suppressing micturition control and reflexes at both the central nervous system level (pontine micturition center) and the level of the peripheral nervous system by blocking neural transmission in the sacral spinal cord.[2][3]
…”

[Good intentions]

They ranked them at the end of that section.

“…
In general, the risk of POUR is most significant in spinal anesthetics, followed by epidural anesthetics followed by general anesthetics.[1]
…”

[William Bryant]

Thanks Good Intentions, I couldn’t see that rating but did find this

“In terms of anesthetic technique and the risk of POUR: spinal is greater than epidural is higher than general anesthesia”. Are any of those local?

[William Bryant]

Also “Herniorrhaphy leads to POUR anywhere between 5.9% and 38% of the time.”

Add in bph and being male and it increases more!

[Author]

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