Bladder distension : aspects of a healthcare-related injury

Lower urinary tract symptoms (LUTS) are common health problems. For the individual, LUTS is troublesome and can greatly affect the health-related quality-of- life (HRQOL). One cause of LUTS is urinary retention (inability to void in the presence of a full bladder); a well-known complication following hospital care. If the bladder volume exceeds 500 ml there is a risk of overdistension of the muscle fibres in the bladder wall; bladder distension. This can result in motility problems with post-void residual volumes, urinary tract infections and an inability to void. If the bladder becomes stretched too far, or for a long period, the bladder may be permanently damaged and lose its ability to contract sufficiently for the rest of the person’s life. Bladder damage due to overdistension can be classified as a patient injury; harm caused to a patient as a result of their healthcare, and which could have been avoided. The overall aim of this thesis was to improve patient-safety by providing research evidence for bladder monitoring procedures and increase knowledge and awareness of bladder distension as a healthcare-related injury. Study I was a prospective observational study of peri-operative bladder volumes among orthopaedic or general surgical patients. Bladder volumes were measured on three occasions; after emptying the bladder before being transported to the operating theatre, and then both immediately before and after surgery. Thirty-three of the included 147 patients (22%) developed bladder distension (>500 ml), eight preoperatively and 25 postoperatively. Orthopaedic patients were more likely to develop both preoperative and postoperative bladder distension than surgical patients and had significantly higher post-void residual volumes Age, gender and time of anaesthesia could not predict bladder distension. Study II was a randomised controlled trial testing whether a protocol with frequent pre-operative ultrasound monitoring of bladder volumes starting in the ER cou