BACKGROUND: Catheterization of the bladder may reduce laparoscopic complications although an enlarged bladder may be impalpable in overweight patients or following previous lower abdominal surgery. METHODS: This study assessed bladder size by manual examination and transcutaneous ultrasound (US). Consecutive patients (n = 90; median age 55 years [20-85]; 61 females) undergoing laparoscopy were studied prospectively. All patients voided preoperatively and catheterization was performed if estimated US bladder volumes exceeded 300 ml. RESULTS: Manual assessment failed to detect bladder enlargement in any patients (sensitivity: 0%; specificity: 4.4%), whereas ultrasound identified four patients at risk of bladder injury due to unsuspected enlargement (4.4%). Three of these patients were either overweight or obese and one patient had previous lower abdominal surgery. Of 12 patients (13%) catheterized, three had or developed urinary tract infections. CONCLUSIONS: Preoperative voiding does not guarantee bladder emptying. Manual examination does not detect bladder enlargement reliably in the obese patient. Ultrasonography may improve patient selection for catheterization.
BACKGROUND: Catheterization of the bladder may reduce laparoscopic complications although an enlarged bladder may be impalpable in overweight patients or following previous lower abdominal surgery. METHODS: This study assessed bladder size by manual examination and transcutaneous ultrasound (US). Consecutive patients (n = 90; median age 55 years [20-85]; 61 females) undergoing laparoscopy were studied prospectively. All patients voided preoperatively and catheterization was performed if estimated US bladder volumes exceeded 300 ml. RESULTS: Manual assessment failed to detect bladder enlargement in any patients (sensitivity: 0%; specificity: 4.4%), whereas ultrasound identified four patients at risk of bladder injury due to unsuspected enlargement (4.4%). Three of these patients were either overweight or obese and one patient had previous lower abdominal surgery. Of 12 patients (13%) catheterized, three had or developed urinary tract infections. CONCLUSIONS: Preoperative voiding does not guarantee bladder emptying. Manual examination does not detect bladder enlargement reliably in the obesepatient. Ultrasonography may improve patient selection for catheterization.
Authors: Gregory J Nason; Sher N Baig; Matthew J Burke; Asadullah Aslam; Michael E Kelly; Leon G Walsh; Hugh D Flood; Subhasis K Giri Journal: Can Urol Assoc J Date: 2015 Jan-Feb Impact factor: 1.862
Authors: Jennifer Meddings; Ted A Skolarus; Karen E Fowler; Steven J Bernstein; Justin B Dimick; Jason D Mann; Sanjay Saint Journal: BMJ Qual Saf Date: 2018-08-12 Impact factor: 7.035