Case report of postoperative urinary retention resolution following neostigmine administration in a patient with multiple risk factors for POUR
- 1University of South Florida Morsani College of Medicine
- 2Department of Anesthesiology and Perioperative Medicine, University of South Florida Morsani College of Medicine
- 3TeamHealth Anesthesia
Abstract
Postoperative urinary retention (POUR) is a common complication of surgery and anesthesia, with an incidence of 4–5% in elective procedures. POUR is traditionally managed with bladder catheterization, which carries risks of infection, urethral trauma, and prolonged hospitalization. Pharmacologic alternatives such as alpha-adrenergic antagonists or cholinergic agonists have been trialed, but with variable efficacy. Neostigmine, an acetylcholinesterase inhibitor, enhances parasympathetic activity to promote detrusor contraction and may represent a noninvasive treatment option, although its use in POUR is rarely reported. We report the case of a 73-year-old male with a history of benign prostatic hyperplasia (BPH), bladder cancer status-post transurethral resection of bladder tumor (TURBT), and interstitial pulmonary fibrosis, who presented for magnetic resonance image (MRI)-guided transperineal prostate biopsy. The procedure was performed under general anesthesia and tolerated without complication. Postoperatively, the patient developed acute urinary retention with a bladder volume of 565 mL that persisted for over 5 h despite ambulation, caffeine, and tamsulosin administration. Wishing to avoid catheterization, the patient elected to trial neostigmine after a risk-benefit-alternatives discussion. A 0.5 mg intravenous injection of neostigmine was administered. Complete voiding occurred within 20 min after the injection without adverse hemodynamic effects, and the patient was discharged home promptly. This case illustrates a temporal association between neostigmine administration and resolution of POUR; a single case cannot establish efficacy or causation.
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BibTeX
@article{daniel2026case,
title = {{Case report of postoperative urinary retention resolution following neostigmine administration in a patient with multiple risk factors for POUR}},
author = {Mitch Daniel and Victoria Martin and John Hodgson and Tanjina Jalil and Enrico Camporesi},
journal = {Discover Medicine},
year = {2026},
month = oct,
doi = {10.1007/s44337-026-00729-y},
url = {https://doi.org/10.1007/s44337-026-00729-y},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case report of postoperative urinary retention resolution following neostigmine administration in a patient with multiple risk factors for POUR
AU - Mitch Daniel
AU - Victoria Martin
AU - John Hodgson
AU - Tanjina Jalil
AU - Enrico Camporesi
PY - 2026
DA - 2026/10/25
JO - Discover Medicine
DO - 10.1007/s44337-026-00729-y
UR - https://doi.org/10.1007/s44337-026-00729-y
AB - Postoperative urinary retention (POUR) is a common complication of surgery and anesthesia, with an incidence of 4–5% in elective procedures. POUR is traditionally managed with bladder catheterization, which carries risks of infection, urethral trauma, and prolonged hospitalization. Pharmacologic alternatives such as alpha-adrenergic antagonists or cholinergic agonists have been trialed, but with variable efficacy. Neostigmine, an acetylcholinesterase inhibitor, enhances parasympathetic activity to promote detrusor contraction and may represent a noninvasive treatment option, although its use in POUR is rarely reported. We report the case of a 73-year-old male with a history of benign prostatic hyperplasia (BPH), bladder cancer status-post transurethral resection of bladder tumor (TURBT), and interstitial pulmonary fibrosis, who presented for magnetic resonance image (MRI)-guided transperineal prostate biopsy. The procedure was performed under general anesthesia and tolerated without complication. Postoperatively, the patient developed acute urinary retention with a bladder volume of 565 mL that persisted for over 5 h despite ambulation, caffeine, and tamsulosin administration. Wishing to avoid catheterization, the patient elected to trial neostigmine after a risk-benefit-alternatives discussion. A 0.5 mg intravenous injection of neostigmine was administered. Complete voiding occurred within 20 min after the injection without adverse hemodynamic effects, and the patient was discharged home promptly. This case illustrates a temporal association between neostigmine administration and resolution of POUR; a single case cannot establish efficacy or causation.
SN - 3004-8885
ER -