Postoperative Vesical Atonia

Definition

Vesical atonia refers to one’s incapacity to empty the bladder. Miction disturbances affect up to 40% of all patients who have undergone any type of radical pelvic surgery (rectum, prostate, and uterus). Vesical atonia, the most severe disturbance, may appear immediately after surgery. Patients simply lose the capacity to urinate. Function loss is permanent if all the nerves that control bladder emptying are destroyed. In such cases, patients must empty their bladder several times a day with a catheter for the rest of their lives. Small pelvis surgery techniques that can spare nerves are thus very important.

In most cases, however, vesical atonia does not immediately deploy its full effects. Temporary miction dysfunction is a classical manifestation that follows radical pelvic surgery. It is thus common to introduce a permanent catheter through the bladder wall already during the operation. Bladder re-education starts immediately after the operation with the urinary catheter still in place. The catheter will be removed only when the volume of residual urine is found to be less than approximately 80 ml. In fact, the amount of residual urine often decreases with time because patients learn how to better empty their bladder (change in position, pressure on the abdomen, etc.). In some cases, and in spite of the treatment, intravesical pressure and the quantity of residual urine continue to rise. The gradual increase in the size of the bladder may lead to hyperdistension, followed by complete bladder atonia. In such cases, patients will be required to use a urinary catheter.

Treatment

Patient autocatheterism (use of urinary catheter) is the treatment of choice in patients suffering from vesical atonia resulting from postoperative nerve lesions. Direct electrostimulation of the bladder is also an option. This technique consists in introducing a saline solution into the bladder using a catheter and applying electrical current to the catheter electrode. The practical outcome is an increasingly urgent need to urinate, which is followed by vesical contraction and miction.

Another option consists in an electrostimulation that targets specific nerve fibres and relaxes the vesical sphincter. The resulting sphincter atonia leads to the emptying of the bladder.

Benefits and Risks

This method allows passive emptying of the bladder. Urinary catheter use is reduced and may even be abandoned in certain cases.