Perioperative bladder management: Assessment of residual pre-operative bladder volume to mitigate post-operative urinary retention

Abstract

Abstract Background: Effective perioperative bladder management aims to limit post-operative urinary retention and its complications. Catheterisation, a standard treatment for post-operative urinary retention, can cause urinary tract infections and trauma. This study aimed to assess pre-operative bladder volume, compare nurse-documented and patient-reported last void times, and evaluate the influence of known risk factors, including urinary symptoms, on pre-operative bladder volume, as well as potentially identifying interventions to reduce post-operative urinary retention. Method: Over three months, bladder ultrasound scans were performed on 200 pre-operative patients at a public hospital in Perth, Western Australia. The study followed the Standards for quality improvement reporting (SQUIRE) guidelines, and the SQUIRE checklist is declared in the materials and methods section. Results: Most patients (79%, n = 158) had bladder volumes below 150 ml; the remainder (21%, n = 42) had volumes exceeding this threshold. Male patients had significantly higher bladder volumes than females, and there was a weak positive correlation between age and pre-operative bladder volume. Older male patients (≥55 years) were more likely to have a bladder volume of more than 150 ml than younger male patients (<55 years). No significant difference was found between nurse-documented and patient-reported last void times, validating the accuracy of nursing records. Female gender and existing urinary symptoms were not significantly associated with pre-operative bladder volumes over 150 ml. Conclusion: Male patients aged over 55 are at increased risk of having pre-operative bladder volumes equal to or exceeding 150 ml and therefore require proactive bladder management to prevent post-operative urinary retention and reduce the need for catheterisation, which may result in infection and trauma. This study highlights the effectiveness of bladder ultrasound scans and accurate nursing documentation in assessing the risk of post-operative urinary retention, promoting informed clinical decision-making and reducing avoidable patient harm. Impact: This study underscores the importance of pre-operative bladder volume assessment in reducing the risk of post-operative urinary retention thus minimising the need for catheterisation and the incidence of related complications, including infection and trauma. Patient contribution: Patients reviewed and improved the written information consent form, enhancing the clarity and effectiveness of the consent process. Keywords: bladder management, bladder ultrasound scans, pre-operative bladder volume, post-operative urinary retention, residual bladder volume, catheter-associated urinary tract infection