1. Kim A. Noble, Ph.D., RN, CPAN knoble@aspan.org MNDALSPAN Fall Conference Saturday, September 26 th, 2015

2. Following attendance in this presentation the participant will: Describe urinary A&P and regulation of function; Identify the influence of anesthesia on urinary function; Describe the assessment and management of urinary retention; Discuss strategies for the care of the perianesthesia patient with urinary retention.

3. The bladder…. Function; More function; Too much…

4. A muscular bag… A complex interaction… ANS influence.

5. Acute –Vs- chronic; Multifactorial causes; Linked to many post-op complications.

6. US Males: 4.5 per 1000; Females: 0.07 per 1000;  risk surgeries: Urologic procedures; Previous voiding problems; Gynecologic procedures; Inguinal hernia repair; Rectal procedures; Administration of IVF; May be asymptomatic

7. The geriatric bladder Anesthesia Pain Bedrest

8. Time to void: Spinal > Epidural

9. Anticholinergic agents; Antipsychotic agents; Class I Antiarrhythmic agents; Antispasmodic agents; Antiparkinsonian agents; Atropine; Histamine (H-1) receptor antagonists; Specific anticholinergics: Chronic airway disease; Overactive bladder Rx.

10. Antidepressants: Tricyclic antidepressants SSRI’s SNRI’s Benzodiazepines

11. Opioids;  -Adrenergic agonists; NSAID’s; Ca ++ channel antagonists.

12. Bladder Volume Instrument  rate of catheterization

15. Buchko, B. L. & Robinson, L. E. (2012, An evidence-based approach to decrease early post- operative urinary retention following urogynocologic surgery, Urologic Nursing, 32(5), 260-273. Drain, C. B. & Odom-Forren, J. (2009). Perianesthesia Nursing: A Critical Care Approach, 5 th ed., St. Louis, MO: Saunders. Faas, C. L., Acosta, F. J., Camobell, M., O’Hagan, C. E., Newton, S. E. & Zagalaniczny, K. (2002). The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary retention and mobility following inguinal herniorrhaphy, AANA, 70(6), 441-447. Joelsson-Alm, E., Nyman, C. R., Lindholm, C., Ulfvarson, J. & Svensen, C. (2009). Perioperative bladder distention: A prospective study, Scandinavian Journal of Urology and Nephrology, 43, 58-62. Joelsson-Alm, E., Ulfvarson, J., Nyman, C. R., Divander, M. & Svensen, C. (2012). Perioperative ultrasound monitoring can reduce postoperative bladder distemtion: A randomized study, Scandinavian Journal of Urology and Nephrology, 46, 84-90. Lau, H. & Lam, B. (2003). Management of postoperative urinary retention: A randomozed trail of in-out versus overnight catheterization, ANZ J, 74, 658-661. Palese, A., Buchini, S., Deroma, L & Barbaone, F. (2010). The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis, Journal of Clinical Nursing, 19, 2970-2979. Verhamme, K., Sturkenboom, C., Stricker, B. H. & Bosch, R. (2008). Drug-induced urinary retention: incidence, management and previention, Drug Safety, 31(5), 373-388.