Post-operative Urinary retention (POUR)  often  goes undetected and if left untreated may have a deleterious effect on bladder function.Neglected POUR is defined as a partially or untreated  POUR which has lead to a prolonged over-distension of the bladder.The Aim of the study is  to  bring to the fore  Neglected POUR as as a distinct entity and to highlight the effect of neglected POUR on bladder function and the role of  early initiation of Intermittent catheterisation(IC)  to recover bladder function.

A retrospective study of 24 patients over 3 years  who presented to Urology department   with recurrent  retention of urine or Overflow Incontinence  in the early post operative period. 
Majority  of patients had  a history of post-operative  catheterisation for Post-operative Urinary retention(POUR) and required a 
re-catheterisation .
Trial without catheter(TWOC)  was given after 5 days of secondary catheterisation.
All patients were treated with  Intermittent catheterisation(IC) after a failed secondary catheterisation for a period upto 4 weeks and  IC volume was noted.
Patients were evaluated at 4 weeks and 3 months  with Uroflowmetry and Urodynamic study.
Voiding pattern and Urodynamic  parameters were analysed against :  Time to Primary and Secondary catheterisation , Volume of Urine drained at catheterisation  to see for statistical association.

: 7 /24 (29%) patients had Urodynamic proven  detrusor dysfunction at 4 weeks and required IC. 
: 15 / 24 (71%)had recovery of detrusor function at end of 4 weeks with spontaneous voiding.
: Time to primary catheterisation (>10 hours)had significant correlation(p<0.05) with bladder dysfunction 
: Volume of retained (>1200 ml) was associated with significant Detrusor dysfunction.
: Time to second catheterisation (> 4days ) had significant correlation with bladder dysfunction. 
: Patients with Overflow incontinence after the first TWOC had significantly higher bladder dysfunction than those with recurrent 
   retention of urine.
: Type and duration of anaesthesia did not affect the detrusor dysfunction dysfunction.
: Presence of prior LUTS and DM did not have a significant co-relation  with bladder dysfunction.
 : In 2 patients delayed recovery occurred after 3 months  both of them had primary retention (<20hours )and secondary retention 
    less than 3 days .

: Neglected POUR is a consequence of undetected or inadequately treated acute retention
: A primary, temporary neurogenic detrusor dysfunction may ensue 
: Persistent  bladder overdistension causes a rise in intravesical pressure accompanied with a drop in bladder blood flow ,progressive 
  intramural ischemia will eventually lead to nerve and muscle damage damage.
:The main factor for detrusor dysfunction was the prolonged over distension which was overlooked because the patient was not in 
 retention but had overflow incontinence.
:It may be treated with a prolonged Indwelling catheter  or Intermittent catheterisation (IC)
:IC may promote early recovery of bladder function with less incidence of CAUTI.
: Parameters which co-relate with  irreversible Detrusor dysfunction are: Time to first catheterisation( more than 10 hours ) and  
  volume of retention more than 1 litre. 
: The most important predictors of recovery of detrusor function  was  retention less than 9 hours,  retention volumes < than 1200 ml 
  and time to second catheterisation (< 3 days )

: Neglected POUR is a distinct entity because  the sequlae of neglected POUR are different from normal POUR and may be 
 permanent.
: The main factor for detrusor dysfunction was the prolonged over distension which was overlooked because the patient was not in retention but had overflow incontinence.
 :The risk of detrusor dysfunction after neglected POUR is real and significant.
: There is a role of early initiation of IC in promoting recovery of bladder function.