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A 45-year-old female is awaiting discharge from the post-anesthesia recovery unit but is unable to void. She is two hours post-completion of a transobturator tension-free vaginal tape procedure for stress urinary incontinence. The procedure was uncomplicated with minimal blood loss. It was performed under spinal anesthesia. Post-procedure cystoscopy was normal. She is in minimal pain after taking ibuprofen and oxycodone. She is tolerating a general diet without nausea. She reports the sensation of a full bladder. She has no significant past medical or surgical history. She is currently taking multivitamins (one tablet PO daily) and has no known drug allergies.
The bladder diary is an important tool in the investigation of patients with lower urinary tract symptoms and voiding dysfunction. There are different methods for recording information on voiding patterns. A frequency-volume chart is the simplest method and collects information on volumes voided and micturition times. A voiding or bladder diary provides a more detailed record. The paper diary is the most common as it is easy to produce and store, inexpensive and convenient to post or hand directly to the patient. The electronic bladder diary such as the UroDiary uses an intelligent character recognition programme and calculates a centile ranking for results, correcting for age and 24-hour voided volume. Bladder diaries are more accurate than recall when recording urinary symptoms. The bladder diaries guide many aspects of conservative treatment, especially timing and types of fluids.
This chapter provides an overview of the range of non-pharmacological management strategies available for bladder symptoms and voiding dysfunction that are usually offered by nurses and physiotherapists that specialize in continence. Many patients with neurological bladder dysfunction drink less as their first strategy to reduce their urinary frequency. A continence assessment should precede any proposed management strategy and this is best carried out by a doctor, nurse or physiotherapist who has an understanding of neurological dysfunction and the possible long-term effect on the patient. Patients with voiding dysfunction complain of hesitancy or difficulty in passing urine. The purpose of indwelling catheters is for short- or long-term urinary drainage when alternative methods of urine drainage are unsuitable or no longer appropriate for the patient. Various drainage bags are available for use with an indwelling catheter. Drainage bags are available with a range of fluid volume capacities from 350 to 2000 ml.
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