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What Causes Acute Urinary Retention After Laparoscopic Incisional Hernia Repair?

Posted on Tue, 29 Dec 2015

Question: Hello, my father recently had incisional hernia repair via robotic laparoscopy. After his surgery, he developed the inability to urinate or feel the sensation to need to. This required intermittent catherization trials but has not worked. He has a history of BPH. Overnight, he developed 1000cc in the bladder and required a flush which resulted in removal of a clot therefore, lovenox at the hospital has been stopped. I am worried, what should we expect now?

Answered by Dr. Dr. P. T. Patil (7 hours later)

Brief Answer:
He has Acute Retention of urine due to Enlarged Prostate .

Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that your father has developed Acute Retention of Urine due to Enlarged Prostate .

I shall be happy if you can post me few more details to help me in making comments on his problem.
1) Was he evaluated for enlarged prostate before surgery of incisional hernia was planned for ?
2) Is he taking any medications for enlarged prostate to improve urine flow ?

In a given situation plan of action should be as follow
1) Catheterize him with self retaining indwelling Catheter(Foley's Catheter) to have continuous drainage of the bladder .
2) Send urine for routine and culture examination
3)Get Ultrasound Scanning of the abdomen and pelvis done to assess the size of the prostate .
4) Give him appropriate antibiotic as per culture report
5) Hive him alpha blockers like Tomsulosin along with Dutasteride once daily .

Remove the catheter after 10 days and give him a trial of voiding .

If he is able to pass urine consult qualified Urologist for opinion regarding further management of BHP whether he needs to undergo endoscopic surgery (TURP) to remove the prostate or can be managed with medications for time being .

In a worst scenario if he is still unable to pass urine the only option is to undergo surgery for resection of enlarged prostate (TURP) to make the urine passage free from obstruction .

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (32 minutes later)

Thank you for your detailed answer. Yes, he has known for several years that he has BPH but was not evaluated for it before the surgery. He has taken Flomax for years and was recently put on Proscar but he is no longer taking Proscar. If he does not pass trial of urine, how much time between the current surgery he just hadand performing a TURP is recommended?

Answered by Dr. Dr. P. T. Patil (14 minutes later)

Brief Answer:
TURP should be done at earliest

Detailed Answer:
Hello
Thanks for follow up .
In a situation if he does not void ,TURP should be done at earliest .

This is safe and painless surgical procedure with less morbidity and gives permanent cure .

Please if you have time post your review about my suggestions on forum of Health Care Magic .

Thanks and Regards
Dr.Patil.

Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar