Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a nonurological population clinical study of the relationship between lower limbs and bladder function

Why upright standing men urinate more efficiently than in supine position: A morphological analysis with real-time magnetic resonance imaging

PURPOSE

Few studies have examined the effects of body position on urination efficiency morphologically. We aimed to dissect out the anatomical changes of pelvic organs during urination in the upright and supine positions by a real-time magnetic resonance imaging (rtMRI) system.

METHODS

Thirteen healthy male volunteers aged 26-60 years were included in the study. The sagittal real-time two-dimensional images were taken to evaluate urinary efficiency, along with change in six morphological indices at the time of storage and the beginning of voiding, in both upright ant supine positions.

RESULTS

Urination was more efficient in upright position than in supine position, as expressed by higher average rate of bladder emptying (9.9 ± 4.2 vs. 6.8 ± 2.9 ml/s, p < 0.05) and also by fewer participants showing significant residual urine (1/13 vs. 7/13, p < 0.05). At the onset of voiding in standing position, the levator ani (LA) muscle moves downward and backward followed by descent of the bladder neck and rotation of the prostate around the symphysis. Such changes were expressed by two morphological indices. One was posterior vesicourethral angle at the start of voiding, 152 ± 7 versus 140 ± 1 in upright and supine position (p < 0.05). The other index was the change in angle between the LA line and pubo-coccygeal line in upright and supine position, 9.4 ± 9.9 versus 1.6 ± 7.9 before voiding (p < 0.05) and 30.2 ± 14.0 versus 17.3 ± 12.9 after the start of voiding (p < 0.05).

CONCLUSION

The dynamic relaxation of LA seemed to be a key movement that enables more efficient urination in standing position than in supine position.

Pelvic Floor Considerations in COVID-19

BACKGROUND

Much of the research and clinical commentary on COVID-19 have been focused on respiratory function. Pelvic floor therapists understand that both respiratory dysfunction and hospitalization can have an impact on pelvic floor function. This clinical commentary provides context as to how the long-term effects of COVID-19 could affect the pelvic floor as well as some generalized treatment considerations.

DISCUSSION

The respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax in a manner that will allow for both continence and elimination. COVID-19 survivors often have disability in this muscle of respiration that can lead to implications for both overactive and underactive pelvic floor. Commonly, this population is hospitalized for long periods of time, which can have long-term consequences on both bladder and bowel functioning including, but not limited to, incontinence, urinary retention, and constipation. Pelvic floor therapists must be prepared to adjust both their evaluation and treatment methods in consideration of this novel treatment population.

CONCLUSIONS

Because of the pervasive nature of this virus, pelvic floor physical therapists should be a part of the rehabilitation team treating these patients once they have become medically stable.Video abstract with sound available at http://links.lww.com/JWHPT/A36.

Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

This study investigates postoperative urinary retention (POUR) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and the effects of postoperative analgesia and mobility on retention. High opioid use and decreased postoperative mobility are proposed risk factors for retention in adults. There is a paucity of literature on POUR in the adolescent population undergoing surgery for AIS. The impact of pain control and mobility on POUR in these patients is unknown.

METHODS

A retrospective cohort study was conducted of adolescents (11-18 years) undergoing elective PSF for AIS at a single institution (2012-2018). POUR was defined as the inability to void > 8 h after catheter removal. Possible risk factors for retention including opioid usage and ambulatory status at the time of catheter removal were assessed on univariate and binomial logistic regression analyses.

RESULTS

One hundred and thirty-six patients were included, with 21 (15.4%) experiencing POUR. On the day of catheter removal, 24 patients had not attempted ambulation; these patients had 2.5 times higher rate of POUR than those who were walking (30% vs. 12%, p = 0.04). Patients who developed retention ambulated a mean threefold shorter distance than those without POUR (45 vs. 136 feet, p = 0.04). On binomial logistic regression, decreased ambulation distance was associated with retention (p = 0.038). While opioid use was not significant on univariate analysis, higher opioid use on the day of catheter removal predicted retention on logistic regression (p = 0.001). POUR resolved in all patients (median duration 0.5 days, range 0-12 days).

CONCLUSIONS

The development of POUR after PSF for AIS affects one in six patients but resolves quickly. Non-ambulatory patients and patients who received large doses of opioids on the day of catheter removal were more likely to develop POUR.

LEVEL OF EVIDENCE

III.