In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood il
Recent reviews of the effect of estrogen on the cardiovascular system suggest that long-term estrogen replacement therapy after menopause may prevent cardiovascular disease in women who are at risk. Short-term effects of estrogen on coronary vascular re
Chlamydia trachomatis and Trichomonas vaginalis are common sexually transmitted infections associated with adverse pregnancy outcome. Since patients are frequently asymptomatic, diagnosis on the basis of symptoms or physical findings is unreliable. If m
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of th
Lindane has been the primary therapy for scabies for more than 30 years. However, because of neurotoxic side effects attributed to this drug, alternative drugs such as 5 percent permethrin have been used, particularly in the pediatric population where t
Clodronate is a second-generation bisphosphonate that has shown the ability to induce substantial gains in bone mineral density when administered in a cyclical regimen in patients with osteoporosis. Because progressive gains in calcium balance and bone
Diagnostic imaging of the spinal canal in the pediatric population is primarily performed to evaluate the presence of congenital malformations, trauma, neoplasms and inflammation. Although magnetic resonance imaging (MRI) is considered the diagnostic mo
Nearly one-half of all spinal injuries occur in motor vehicle accidents, with falls, sports injuries and assaults comprising the remainder. One-half of all spinal injuries occur in the cervical region, with associated risks of quadriplegia. Patients wit
Acetaminophen is believed to produce analgesia primarily through peripheral effects. It has become widely used for analgesia both under medical supervision arid as an over-the-counter agent. Codeine is believed to act mainly within the central nervous s
The American Academy of Pediatrics (AAP) has issued a policy statement discussing current recommendations based on the latest research on car seats and the factors parents should consider before selecting and using a car seat for their child. Despite th
Date: August, 1991
The incidence of urinary retention after general surgical procedures has ranged from 7 percent to 52 percent. Urinary retention is a common complication of inguinal hernia repair, but contributing b factors have not been identified. To clarify these factors, Petros and colleagues retrospectively studied patients who underwent elective inguinal herniorrhaphy.
The study included 295 male patients who underwent herniorrhaphy between 1986 and 1989. Patients with a history of urinary retention, previous transurethral surgery, prostatic hypertrophy or use of medications associated with urinary retention were excluded from the study. Surgery was performed after the administration of either a general anesthetic (halothane) or a short-acting spinal anesthetic (5 percent lidocaine). Catheterization was performed only when the bladder was palpable or the patient was uncomfortable.
Urinary retention occurred in 41 (14 percent) of the patients. The type of hernia (direct or indirect) and the side of the body in which it was located were not associated with urinary retention.
Retention was significantly more common in patients 53 years of age or older than in younger patients. Use of general anesthetic was also associated with a significantly increased incidence of retention. This risk persisted after controlling for age. The volume of intravenous fluid received in the perioperative period was also associated with urinary retention. Patients who received more than 1,200 mL of fluid had a significantly increased risk of retention, although this association diminished after controlling for age and type of anesthesia used.
The authors suggest that urinary retention after hemiorrhaphy may be prevented by limiting the amount of fluid given perioperatively and using a spinal anesthetic rather than a general anesthetic, particularly in older patients. (American Journal of Surgery, April 1991, vol. 161, p. 431.) N
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group