General characteristics and etiology of complications
Any surgical intervention carries a risk of undesirable consequences. In clinical practice, all occurring complications are strictly classified depending on the time of their manifestation: they are divided into early and late.
Understanding the etiology of early complications is of critical importance for a practicing physician. The fundamental causes of such pathological conditions lie in three main aspects, which are evaluated comprehensively:
- Underlying disease. The specificity and severity of the pathology for which the surgery was performed.
- Surgical trauma and anesthesia. The scale of tissue damage during the surgery and the systemic effect of anesthesia on the body.
- Comorbid pathology. Exacerbation or decompensation of chronic diseases against the background of surgical stress.
Speaking specifically about the early postoperative period, the leading role in the genesis of complications is played by specific factors. These include the pronounced depressant effect of various narcotic substances used for pain relief. In addition, a critical factor is uncompensated water-electrolyte disturbances that destabilize the patient's homeostasis in the very first hours after the intervention.
Complications of the urinary system
One of the most indicative and frequently encountered variants of early problems is acute urinary system dysfunction, namely — urinary retention (ischuria).
From an etiology standpoint, postoperative ischuria is predominantly reflex in nature. The mechanism of its development is closely associated with pronounced pain syndrome, which inevitably accompanies the early postoperative stage. Intense pain provokes pathological spasm of the musculature. This process involves the muscles of the anterior abdominal wall (abdominal press), pelvic floor muscles, as well as the sphincter apparatus of the urinary bladder itself. As a result of this massive reflex spasm, the patient completely loses the ability to independently and adequately empty the bladder.
Algorithm for managing patients with urinary retention
The management tactics for surgical patients with urinary excretion disorders are strictly regulated and depend on the severity of the initial condition, as well as the effectiveness of conservative steps taken.
- Prophylactic drainage. In patients in severe condition, as well as after performing large-scale, highly traumatic surgical interventions, the method of choice is the preventive placement of an indwelling catheter. Most often, a Foley catheter is used. This is necessary for strict hourly diuresis monitoring.
- Conservative therapy. If urinary retention has already developed, one starts with the simplest and most sparing measures. The patient is administered adequate doses of painkillers and antispasmodic agents to relieve reflex muscle spasm. A warm heating pad is placed locally on the suprapubic area. An important step is early mobilization — for example, men, if their condition allows, are allowed to stand up for physiological relief of urination.
- Bladder catheterization. In a situation where conservative measures have not brought the expected effect, the physician moves on to instrumental methods. Initially, a soft urethral catheter is used. If it cannot be passed, a rigid (metal) catheter is used.
- Surgical correction. This is an extreme measure used when transurethral catheterization is absolutely impossible. A classic example of such a situation is the presence of benign prostatic hyperplasia (BPH) in the patient, which mechanically blocks the urethra. In this case, surgical intervention is indicated — creation of a suprapubic fistula (cystostomia).
Briefly: answers to topical questions
What are the indications for creating an epicystostomy in acute urinary retention?
The indication for creating an epicystostomy (suprapubic fistula) in acute urinary retention is the impossibility of bladder catheterization. Such a situation may arise, for example, in benign prostatic hyperplasia.
What early postoperative complications can develop from the respiratory system?
The following complications and conditions from the respiratory system may develop or be prevented in the early postoperative period:
- pulmonary congestion;
- atelectasis;
- hypostatic pneumonia;
- postoperative pneumonia, including after major surgeries or inhalation anesthesia;
- postoperative respiratory failure is mentioned among postoperative complications.
What early postoperative complications occur from the cardiovascular system?
In the postoperative period, hemorrhagic and thromboembolic complications may occur from the cardiovascular system and hemostasis:
- postoperative bleeding;
- large hematomas;
- vein thrombosis, including deep vein thrombosis of the lower extremities;
- pulmonary embolism;
- acute-onset heart dysfunction.
What drugs are used for medical stimulation of urination in postoperative ischuria?
In postoperative urinary retention, as a conservative medical measure, the administration of painkillers and antispasmodic agents is indicated. If conservative measures are ineffective, catheterization with a soft catheter is performed, and if that fails, with a rigid metal catheter.
What early local complications of the surgical wound are distinguished?
Local complications of the surgical wound confirmed by sources include:
- suppuration of the postoperative wound;
- delayed healing;
- purulent wound complications, including purulent pockets, phlegmon, and abscesses;
- hematoma formation;
- wound dehiscence.
To memorize the assistance algorithm for acute postoperative ischuria, use the step rule: "First anesthetize and warm, then insert a soft catheter, if it fails — take a rigid one, no way through — form a fistula."
Class and exam questions
Within what timeframe do early postoperative complications develop?
They occur in the first hours and days after the end of surgical intervention, unlike late complications that develop in more remote periods.
Why does reflex urinary retention occur after surgery?
The main cause is pronounced pain syndrome, which causes spasm of the abdominal muscles, pelvic floor, and bladder sphincters, preventing normal urination.
What should be done if conservative measures for ischuria prove ineffective?
When painkillers, antispasmodic agents, and thermal procedures are ineffective, bladder catheterization with a soft catheter is indicated, and upon failure — with a rigid catheter.
In what cases is cystostomy placement resorted to?
Creation of a suprapubic fistula (cystostomy) is performed when transurethral catheterization is physically impossible, for example, due to pronounced benign prostatic hyperplasia.
What else to study on this topic
- Late postoperative complications: classification and timeframes
- Mechanisms of depressant action of narcotic substances on organs
- Water-electrolyte disturbances in surgery: types and compensation methods
- Technique of indwelling Foley catheter placement
- Benign prostatic hyperplasia as an obstacle to catheterization
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