I rececently had abdominoplasty. Trouble with urination began the evening after surgery. Unable to empty bladder. Undetected by surgeon four days after surgery. Also was taking Mepergan for pain. On fifth day urologist was consulted and he diagnosed this as an anesthesia complication and inserted foley catheter. Must wear this for five days. Was the problem caused by the anesthesia or the continued use of Mepergan? 

Your problem is known as postoperative urinary retention.ﾠ Urinary retention is the failure to empty the bladder when it is full of urine.ﾠ There are a number of things associated with urinary retention after surgery, which is a surprisingly common condition.ﾠ These include age (older), previous urinary problems, a large amount of fluid received during or after surgery, prostate enlargement (men), site of surgery (hernia), and type of anesthesia (spinal or epidural anesthesia).ﾠ 

In a recent study which used ultrasound to measure the amount of urine in the bladder, the best predictor of urinary retention was the amount of urine in the bladder immediately after surgery. ﾠIf the full bladder is not emptied this can cause persistent problems because of the prolonged stretching of the bladder (detrusor) muscle.ﾠ 

Unfortunately many patients with full bladders after surgery cannot tell that their bladder is full.ﾠ Ultrasound machines are not usually available (except in research studies!) and recovery room nurses must rely on the patient's symptoms or on their ability to assess the bladder size by feeling the patient's abdomen.ﾠ This is a very inaccurate method and is why the authors of the study recommend that ultrasound equipment be used routinely in the recovery room.ﾠ If urinary retention is recognized in the recovery room, the bladder can be emptied with a urinary catheter.ﾠ This is a tube placed through the urethra into the bladder. ﾠThe catheter may be retained for a time or may be used to empty the bladder and then is removed.ﾠ 

When surgery is prolonged, or the operation is one in which a lot of fluid must be given or blood is lost, it is usual practice to insert a urinary catheter at the beginning of the procedure.ﾠ This will help prevent problems of urinary retention in the early recovery period.ﾠ The decision to place a urinary catheter is usually made by the surgical team and the anesthesiologist.ﾠ 

Another cause of urinary retention is the use of medication with "anticholinergic" properties.ﾠ Among the many medicines that have this effect is promethazine, one of the drugs contained in Mepergan (a combination of meperidine, a pain killer, and promethazine).ﾠ 

While anesthetic factors may have contributed to urinary retention, you can see that this is a not uncommon condition (16% in the study I've quoted), and there are a variety of possible causes, and of methods for detection or early prevention.ﾠ 

I hope you recover soon.ﾠ For more information I suggest you speak directly with your surgeon and with your anesthesiologist, who is likely to be very glad to respond to your concerns. 

I am 75 yo man. I have had surgeries for replaced knees, bladder tumors, and others, all with GA. After all the work is done and I am back home or in the hospital room I can never pee. A catheter has to be put in always. A lot of hospital and Dr. office people have told me that the anesthesia has affected my bladder muscle and it won`t squeeze the pee out. After 4-5 days when the catheter is taken out, I can pee again, but even then it takes a few days to get back to normal. Is there anything the anesthesiologist can do so my bladder will not be so affected? It is not a blockage like an enlarged prostate or anything (my urologist has confirmed that) but just the inability of the bladder to empty itself. 

Thanks for your interesting question. Studies have shown that anesthesia is only one of several factors that can cause your problem, which is known as urinary retention. But there is a perhaps understandable tendency among some doctors to blame anesthesia for anything that goes wrong after surgery! As anesthesiologists, we are accustomed to this phenomenon and usually are able to make light of it with our surgical colleagues. 

• Spinal or epidural anesthesia is a well known cause of urinary retention; in these cases, the retention usually lasts only a few hours and can be remedied by emptying the bladder with a catheter during that short period of time while the anesthetic wears off. 
• Specific anesthetic agents used in premedication and in general anesthesia seem to have little to do with urinary retention. Similarly, analgesic (pain) medications probably have little effect. 
• Surgery of the pelvis or urinary tract can cause urinary retention through inhibition of bladder reflexes caused by surgical manipulation. 
• Another factor that can prevent the bladder from emptying normally is excess fluid administration resulting in bladder distension. Pain and anxiety can also contribute to the problem. 
• The effects of non-anesthetic medications can play a part; the medications that do this, such as anticholinergic medications, have effects on parts of the autonomic nervous system which control bladder emptying. 
• Inability to stand or sit after surgery has been found to be a common cause of retention. 
• In older men, enlargement of the prostate gland is a frequently leads to retention. 

Unfortunately, patients who have had urinary retention, like yourself, are at particularly high risk of having this happen again. Individuals with this problem often have an abnormal voiding history before the surgery, which may indicate the presence of an "occult" (silent) neuropathic (nerve) or obstructive bladder disorder. The fact that you have previously had surgery on your bladder makes me suspect that this is case; however this is only speculation, not a diagnosis, and you should discuss this in detail with your urologist. Your urologist may be able to do special tests to determine whether there is a subtle bladder problem which is your predisposing factor for postoperative urinary retention. 

Regrettably therefore, there is probably not much your anesthesiologist can do to prevent this from happening again. However, you should definitely discuss this problem with both your surgeon and your anesthesiologist before any subsequent surgery to try and address correctable factors, such as those I've mentioned, before, during and after the surgery.