رجل عمره ٦٤ سنة بعد عملية فتق تحت تخدير نخاعي بـ ٨ ساعات، أخذ مورفين ولم يتبول منذ العملية. يشعر بانزعاج أسفل البطن ورغبة في التبول ولا يقدر. السوائل الوريدية ١٥٠٠ مل. ما أول إجراء؟

A 64-year-old man is 8 hours after hernia repair under spinal anaesthesia, has had morphine and has not voided since surgery. He has lower abdominal discomfort and an urge but cannot void. IV fluids total 1,500 mL. What is the first action?

1. Give an IV diuretic to stimulate the kidneys
2. Insert an indwelling catheter straight away for days
3. Restrict fluids until he voids by himself
4. Measure bladder volume with a portable bladder scanner

Answer: D) Measure bladder volume with a portable bladder scanner. Post-operative retention is common after spinal anaesthesia and opioids. Scan volume first, try measures to aid voiding, then intermittent catheterisation if the volume is large.