Chronic Urinary Retention Postpartum

EDITORIAL COMMENT: Chronic urinary retention is a problem seldom encountered by the obstetrician gynaecologist. The most common presentation of this vexing complication is following removal of an indwelling urethral catheter after vaginal hysterectomy or Manchester repair, surgery for stress incontinence of urine, or radical surgery for pelvic cancer. In these patients the residual volume after voiding usually falls to acceptable levels (100–200ml) after an indwelling urethral catheter has been reinserted for 48 hours with appropriate treatment of urinary infection if present. This paper describes chronic urinary retention postpartum which must be a very rare problem in obstetric practice or else one that goes unrecognized, since the editor cannot recall seeing such a case other than in patients with extensive vulval, paravaginal or pelvic haematomas associated with difficult forceps delivery or hysterectomy for uterine rupture. Gynaecologists aim to have their patients achieve low residual urine volumes (below 100ml) before discharge home after surgery ‐ in the occasional patient who is voiding reasonable volumes but who has a high residual volume, bladder function usually progressively improves if the patient is allowed home ‐ these women should be followed‐up to check that they have not developed chronic urinary retention with the risk of upper urinary tract damage. In previous years these patients suffered the miseries of prolonged hospitalization and repeated episodes of indwelling urethral catheterization. Suprapubic catheterization seems preferable to intermittent self catheterization which is sometimes used for gynaecological patients with postsurgical voiding problems. The take away message for readers is to be on the look‐out for chronic urinary retention and to consider increasing the use of suprapubic catheterization in gynaecological practice ‐ we will be pleased to learn if the treatment regimen described in this paper is equally effective in the older gynaecological patient. We have no experience of postpartum suprapubic catheterization but would expect the size of the postpartum uterus and increased pelvic congestion to provide additional hazards ‐ it is certainly quite common to see evidence of gross tubal and pelvic congestion (? inflammation) in asymptomatic patients at the time of tubal ligation performed within a few days of delivery. Correspondence with Dr Jeffery indicates that since treating the patients described in this paper, he has adopted a policy of inserting an indwelling Foley catheter immediately after delivery in all patients who require epidural analgesia during labour; the catheter is removed 4–5 hours after delivery when the patient has a return of normal lower abdominal and pelvic sensation. Summary: Three cases of chronic urinary retention postpartum are reported. All patients were primigravidas. Unrecognized urinary retention following epidural anaesthesia in labour was the likely cause. Abdominal ultrasound may have a place in early recognition of this complication. The early use of a suprapubic catheter hastens bladder recovery.