Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Int J Womens Health. 2014 Aug 28;6:829-38. doi: 10.2147/IJWH.S55383. eCollection 2014.
Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%-43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function - the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4-6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk - either due to the procedures being performed or their clinical risk factors - should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair.
术后尿潴留（POUR）是妇科手术后的常见后果，尤其是在进行尿失禁和盆腔器官脱垂的手术矫正时。盆腔手术后发生潴留的估计率为 2.5％-43％。虽然没有 POUR 的标准定义，但它的特征是膀胱排空受损，残留尿液量增加。管理 POUR 的关键是早期识别。所有接受盆腔手术的患者，尤其是接受失禁或脱垂矫正的患者，在出院前应评估排尿功能。有几种评估排尿功能的方法-金标准是测量残余尿量。POUR 的管理相当简单。目的是排空膀胱，以避免长期损害膀胱完整性和功能。可以通过测量残余尿量来持续评估术后何时停止辅助膀胱引流的决策。4 周以上的 POUR 持续时间延长的发生率较低，因此大多数保留可自行在 4-6 周内自发解决。当 POUR 不能自发解决时，可能需要更积极的治疗。技术包括尿道扩张，吊带拉伸，吊带切开，部分吊带切除和尿道切开术。尽管不可避免地存在 POUR 的风险，但有些风险因素是可以改变的。由于手术或临床危险因素而处于更高风险的患者，应在手术前对 POUR 的风险和管理选择进行咨询。尽管 POUR 是一种严重的疾病，如果不治疗可能会产生严重后果，但它易于诊断，并且通常可以自行解决。临床医生对该疾病的认识以及对其诊断的警惕性是成功治疗接受手术修复的患者的关键因素。
