Surgical Management of Urinary Retention

Raymond R. Rackley and Tara L. Frenkl

Clean intermittent catheterization (CIC) is one of the major advances in the history of urologie practice. Developed in 1972 by Jack Lapides and colleagues,1 this nonsterile technique has been adopted worldwide and few advances in urology have had the same impact on clinical practice and patient management as CIC for bladder evacuation or emptying dysfunction. It has implications for overactive bladder caused by elevated postvoid residuals (PVR), bladder outlet obstruction resulting in high voiding pressures or various degrees of urinary retention, as well as infectious urinary tract conditions because it actually results in improved urologic care and fewer complications than previously considered management options. Clean intermittent catheterization has improved the quality of life for countless people with transient or permanent voiding dysfunction who might otherwise have been treated with chronic indwelling catheters or surgery for urinary diversion such as an ileal conduit. This technique has allowed for the evolution of numerous surgical techniques for pelvic organ reconstruction such as antiincontinence procedures, as well as orthotopic and nonorthotopic urinary diversions.

Clean intermittent catheterization is indicated if it represents the best option for urinary drainage in a patient with bladder-emptying dysfunction. By far, the most common indication for CIC is chronic bladder dysfunction as a result of non-neurogenic, as well as neurogenic conditions. Medical management of severe neurogenic and non-neurogenic detrusor instability can convert a bladder-storage problem into a bladder-emptying problem that, when managed successfully with the potential use of CIC, provides for a condition of continence. Likewise, people with overflow incontinence from hypocontractile conditions and chronic retention can avoid indwelling catheters with CIC. In patients with retention secondary to outlet obstruction from conditions such as pelvic organ prolapse, CIC is helpful when surgery must be delayed or avoided because of medical conditions. The entire field of reconstructive urology and continent urinary reservoir creation depends on CIC to ensure urinary drainage and is the reason for including this concept at the beginning of this chapter.

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