in my opinion good urine microscopic examination and culture sensitivity to rule out any infection. micturating cystourethrogram to rule out any injury.some time Bladder atonicity can occure because of denervation, so ratherthan intermittent catheteraisation i feel catheterise the patient and investigate and treat the cause accordingly. 

Dear Rajshree

Thank you about your answer, it is so important to help me solving that situation once it involves  a young woman. About urine examination and cystourethrogram, both of them have already been requested and I'm expecting its results.

Anyway, I'll give you future details about the case evolution.

Thank u sir

bladder atony is a common postoperative complication after radical hysterectomy. The higher the Rutledge type carry higher risk. We routinely keep the catheter for 3-5 days postoperatively and check for post void rest soograpically. In case of rest above 120ml , we recatheter and keep it for 2-3 more days and recheck for rest and culture. In case of refalure we repeat and recheck wekly for a month.  We do not cystoscope the patient. Only 2 of our patients over the last 4 decades failed this and need life intermittent catheterizations.

Dear Jacob

Thanks for your answer, I'm going to in the way you have addressed and hope to have that problem solved as quick as possible. There is much time I don't have a definitive lost bladder contraction. Indeed I had just one case during all my medical pratice.

Dear Claudio Sergio Batista

I completely agree with Jacob Korach, and in my experience there is a very rare patients with urinary retention defined as residual urine volume greater than 120 ml 4 weeks after radical hysterectomy. My questions focused the operative speciems, do you have exact measure of removed vagina measured verticaly and the measure of removed lateral and posterior parametria. I suppose than in this case nerve sparing was not performed. In the cases where atony of the bladder is present more than three weeks, we also try to introduce in the bladder (treat the bladder) with prostaglandin, but the treatment has dubious outcome

Dear Herman

Thanks for reply. Really, it's possible to have a nervous damage once it is an expected surgery side effect.

Patient was submitted to urodynamic testing, and it shows detrusor hyperactivity with hypotonicity so I hope we'll have a probability that bladder come back its normal function in medium term of  about 6 months.

Any way I'll consider your suggestion.

You keep the catheter but not with a bag. You must put at the end of the urinary catheter a plug. So when the women feels that the bladder is full ,take out the plug and recommend her to make Valsalva manouver to help the evacuation of the bladder. So she will bring up her bladder. There are a kind of exercises for bladder muscle. 

Dear Michaela

I have already carried out this practice with the patient, and last time we were together she mentioned having miccional desire when she goes evacuate her intestine.

Anyway, I thank you for this contribution and after next patient apointment, I'll return for all how patient is.

Dear all

As I promissed I'm giving you news about Wertheim-Meigs patient urinary retention, so I inform patient urinary function returned after 3 weeks of intermitent catheterism and now her is well on general post-operatory context.

Once again I thank you for your contribution

Best wishes