Urinary Retention

This complication is seen in about 16% of proctec-tomies[109,110] but fortunately when it happens it is usually transitory. Both sexes are at risk, although the highest incidence is in older men with benign prostatic enlargement [109,110]. Other contributing factors include history of bladder over-distension, poor bladder contractility and inhibition of the micturition reflex secondary to pain. It also may be more common in long-term anti-cholinergic users [110].

Bladder dysfunction often results from direct damage to the autonomic nerve plexus during pelvic dissection. Critical areas are represented by the pos-terolateral ligaments, where both sympathetic and parasympathetic branches constitute the inferior hypogastric plexus, the anterolateral ligaments and anteriorly the plane of Denonvilliers' fascia, which protects the vesical and prostatic plexus [111]. A complete section of nerve trunks is less common but results in permanent lesion. More often nerves are stretched or peripheral branches are sectioned, resulting in transitory problems [112]. The most frequent abnormality is temporary loss of bladder sensation [113]. Less frequently, damage can result as detrusor hypocontractility, bladder neck incompetence, loss of bladder compliance, bladder outlet obstruction[114,115].

A better knowledge of the pelvic anatomy and application of TME surgery and nerve sparing techniques, both for malignant and benign colorectal disease, have been essential in minimising this problem [111, 116-118]. In a Dutch series of 76 patients who received a proctocolectomy with TME followed by an ileal pouch-anal anastomosis, the incidence of severe bladder dysfunction was zero [119].

Usually retention can be prevented if the catheter is left in situ for at least 48-72 h postoperatively. Prophylactic administration of alpha adrenergic blockade has been effective in some series [120,121], while the use of parasympathicomimetic drugs did not show any benefit [122].

Urological consultation and urodynamic studies are suggested when retention persists beyond a week. However, most of these cases settle after 2-4 weeks of intermittent self-catheterisation. Sometimes resolution of symptoms requires a longer period. Del Rio et al. [123] followed-up of 14 patients in whom micturition disorders were still present 3 months after the operation and noticed that 6 of them were still symptomatic after 12 months and 3 after 3 years. Patients with permanent damage are doomed to intermittent self-catheterization.

Was this article helpful?

0 0
Mole Removal

Mole Removal

Moles, warts, and other unsightly irregularities of the skin can be bothersome and even embarrassing. They can be removed naturally... Removing Warts and Moles Naturally! If you have moles, warts, and other skin irregularities that you cannot cover up affecting the way you look, you can have them removed. Doctors can be extremely expensive. Learn the natural ways you can remove these irregularities in the comfort of your own home.

Get My Free Ebook

Post a comment