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Cambise C, De Cicco R, Luca E, Punzo G, Di Franco V, Dottarelli A, Sacco T, Sollazzi L, Aceto P. Postoperative urinary retention (POUR): A narrative review. Saudi J Anaesth 2024; 18:265-271. [PMID: 38654881 PMCID: PMC11033892 DOI: 10.4103/sja.sja_88_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
Postoperative urinary retention (POUR) is defined as the inability to void in the presence of a full bladder after surgery. Complications include delirium, pain, prolonged hospitalization, and long-term altered bladder contractility. Comorbidities, type of surgery and anesthesia influence the development of POUR. The incidence varies between 5% and 70%. History and clinical examination, the need for bladder catheterization and ultrasonographic evaluation are three methods used to diagnose POUR. The prevention of POUR currently involves identifying patients with pre-operative risk factors and then modifying them where possible. Bladder catheterization is the standard treatment of POUR, however, further studies are necessary to establish patients who need a bladder catheter, bladder volume thresholds and duration of catheterization.
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Affiliation(s)
- Chiara Cambise
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Roberto De Cicco
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Ersilia Luca
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Giovanni Punzo
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Valeria Di Franco
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Alessandra Dottarelli
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Teresa Sacco
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
| | - Liliana Sollazzi
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Aceto
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Lee YW, Kim BS, Chung J. Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2024; 103:41-48. [PMID: 34281423 DOI: 10.1177/01455613211033112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. METHODS A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. RESULTS Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. CONCLUSIONS General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.
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Affiliation(s)
- Yong Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Daejeon Hospital, Daejeon, Republic of Korea
| | - Bum Sik Kim
- Department of Urology, Veterans Health Service Daejeon Hospital, Daejeon, Republic of Korea
| | - Jihyun Chung
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chau LC, Jarman A, Prater A, Ferguson R, Soheim R, McFarlin K, Stanton C. Effect of neuromuscular blockade reversal on post-operative urinary retention following inguinal herniorrhaphy. Hernia 2023; 27:1581-1586. [PMID: 37737305 DOI: 10.1007/s10029-023-02857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aims to define the risk of post-operative urinary retention (POUR) following inguinal hernia repair in those that received sugammadex compared to anticholinesterase. METHODS Adults undergoing inguinal herniorrhaphy from January 2019 to July 2022 with at least 30-day follow-up receiving rocuronium or edrophonium and reversed with an anticholinesterase or sugammadex were included. 1-to-2 propensity score matched models were fitted to evaluate the treatment of effect of sugammadex vs. anticholinesterase on POUR, adjusting for patient comorbidities, ASA class, wound class, operative laterality, urgency of case, and open versus minimally invasive repair. RESULTS 3345 patients were included in this study with 1101 (32.9%) receiving sugammadex for neuromuscular blockade reversal. The 30-day rate of POUR was 2.8%; 1.4% in the sugammadex and 4.4% in the anticholinesterase group. After propensity score matching, patients receiving sugammadex had significantly lower risk of POUR compared to anticholinesterase overall (OR 0.340, p < 0.001, 95% CI 0.198-0.585), in open (OR 0.296, p = 0.013, 95% CI 0.113-0.775) and minimally invasive cases (OR 0.36, p = 0.002, 95% CI 0.188-0.693), unilateral (OR 0.371, p = 0.001, 95% CI 0.203-0.681) and bilateral repairs (OR 0.25, p = 0.025, 95% CI 0.074-0.838), elective (OR 0.329, p < 0.001, 95% CI 0.185-0.584) and clean cases (OR 0.312, p < 0.001, 95% CI 0.176-0.553). CONCLUSIONS The incidence of 30-day new onset POUR was 2.8%. Sugammadex was associated with significantly lower risk of POUR after inguinal herniorrhaphy compared to anticholinesterase overall and when stratifying by operative modality, laterality, and wound class.
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Affiliation(s)
- Lucy Ching Chau
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
| | - Alexa Jarman
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Aaron Prater
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Ryan Soheim
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kellie McFarlin
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Cletus Stanton
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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Serra-Aracil X, Hidalgo JM, Dominguez A, Vallverdu H, Millan M, Caro-Tarragó A, Delgado S, Gomez C, Llorach N, Mora-Lopez L. Multicentre, prospective, randomized control non-inferiority trial of bladder catheter management in colon surgery. Colorectal Dis 2023; 25:1506-1511. [PMID: 37874041 DOI: 10.1111/codi.16593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/17/2022] [Accepted: 04/01/2023] [Indexed: 10/25/2023]
Abstract
AIM Perioperative bladder catheterization is a controversial issue. Most current recommendations are based on data from open surgery extrapolated to enhanced recovery after surgery or fast-track programmes ranging between 24 and 48 h. The aim of this study is to provide a rationale for reducing catheterization time while at the same time avoiding acute urine retention (AUR), in patients undergoing scheduled laparoscopic colon surgery. METHOD This is a multicentre, prospective, controlled, randomized non-inferiority study of bladder catheter management in patients undergoing scheduled laparoscopic colon surgery, randomized into two groups: experimental (with catheter removal immediately after surgery) and control (with catheter removal 24 h post-surgery). The main outcome will be the development of AUR, and secondary outcomes the development of urinary infection within the first 30 days and hospital stay. Demographic, surgical and pathological variables will also be evaluated, especially the development of adverse effects assessed according to the Clavien scale and the Comprehensive Complication Index. Following the literature, we assume an incidence of AUR of 11% and a margin of non-inferiority (delta) of 8% and estimate that a sample size of 208 patients per group will be required (with an estimated 10% of losses per group). CONCLUSIONS In this study we try to demonstrate that the bladder catheter can be removed immediately after scheduled laparoscopic colon surgery, without increasing acute urine retention. This measure would offers the benefits of earlier mobilization and reduces catheter-related morbidity.
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Affiliation(s)
- Xavier Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Institut d'investigació i innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Jose M Hidalgo
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Institut d'investigació i innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Arturo Dominguez
- Urology Department, Parc Tauli University Hospital, Sabadell, Spain
| | - Helena Vallverdu
- Coloproctology Unit, General and Digestive Surgery Department, Vic University Hospital, Barcelona, Spain
| | - Monica Millan
- Coloproctology Unit, General and Digestive Surgery Department, La Fe University Hospital, Valencia, Spain
| | - Aleidis Caro-Tarragó
- Coloproctology Unit, General and Digestive Surgery Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Salvadora Delgado
- Coloproctology Unit, General and Digestive Surgery Department, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - C Gomez
- Coloproctology Unit, Coloproctología, Cirugía General y del Ap. Digestivo, ALTHAIA, Xarxa Assistencial Universitària de Manresa - Sant Joan de Déu Hospital, Manresa, Spain
| | - Nuria Llorach
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Institut d'investigació i innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Laura Mora-Lopez
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Institut d'investigació i innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Arora GS, Kaur P. Acute Delirium Post-inguinal Hernia Mesh Repair in a 40-Year-Old Male: An Unusual Case of Cystocerebral Syndrome. Cureus 2023; 15:e42260. [PMID: 37605679 PMCID: PMC10440094 DOI: 10.7759/cureus.42260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Acute urinary retention is a known complication of inguinal hernia repair. However, the development of severe agitation and delirium as a result of acute urinary retention following inguinal hernia repair is less commonly reported. Here, we present the case of a 40-year-old male with no relevant medical history who underwent open mesh hernia repair for an uncomplicated left-sided indirect inguinal hernia. Postoperatively, the patient became hypertensive, delirious, and violent. He was found to have urinary retention on a bladder scan. Urgent intervention with catheterization and bladder decompression resulted in the prompt resolution of the patient's symptoms. The patient regained his senses and did not remember the events that led to it. This case highlights the importance of recognizing and managing acute urinary retention to prevent the development of severe agitation and delirium following spinal anesthesia. Further research and awareness are necessary to better understand the underlying neurovisceral mechanisms and optimize preventive strategies.
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Affiliation(s)
- Gagandeep Singh Arora
- Internal Medicine, University of California Riverside, San Bernardino, USA
- General Surgery, Government Medical College, Patiala, Patiala, IND
| | - Parneet Kaur
- Emergency Department, Civil Hospital Mukerian, Mukerian, IND
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
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Kim IK, Lee CS, Bae JH, Han SR, Lee DS, Lee IK, Lee YS. Immediate urinary catheter removal after colorectal surgery with the enhanced recovery after surgery protocol. Int J Colorectal Dis 2023; 38:162. [PMID: 37284881 DOI: 10.1007/s00384-023-04460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The Enhanced Recovery After Surgery protocol for colorectal surgery recommends early urinary catheter (UC) removal after surgery. However, the optimal timing remains controversial. We aimed to evaluate the safety of immediate UC removal and risk factors of postoperative urinary retention (POUR) after colorectal cancer surgery. METHODS From November 2019 and April 2022, patients who underwent elective colorectal cancer surgery at Seoul St. Mary's hospital were collected retrospectively. A UC was inserted in the operating room after general anesthesia and removed in the operating room immediately after surgery. The primary outcome was the occurrence of POUR following immediate UC removal after surgery, and the secondary outcomes were the identification of POUR-related risk factors and postoperative complications. RESULTS Among 737 patients, 81 (10%) had POUR immediately after UC removal. No patient had urinary tract infection. The incidence of POUR was significantly higher in male and in those with a history of urinary disease. However, there were no significant differences in tumor location, surgical procedure, or approach. The mean operative time was significantly longer in the POUR group. Postoperative morbidity and mortality rates did not differ significantly between two groups. Multivariate analysis showed that risk factors for POUR were male, a history of urinary disease, and intrathecal morphine injection. CONCLUSIONS Immediate removal of UC immediately after colorectal surgery is safe and feasible in the trend of ERAS. Male, a history of benign prostatic hyperplasia, and intrathecal morphine injection were risk factors for POUR.
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Affiliation(s)
- In Kyeong Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seung Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Do Sang Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Magnuson JA, Hobbs JR, Snyder V, Hozack WJ, Krueger CA, Austin MS. Routine Use of Bladder Scans After Primary Total Joint Arthroplasty is Not Necessary: Results of a Protocol Change. J Arthroplasty 2023; 38:S52-S59. [PMID: 36822446 DOI: 10.1016/j.arth.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Postoperative urinary retention is a common concern after total joint arthroplasty (TJA) and can cause discomfort, incontinence and, if left untreated, myogenic changes to the bladder. However, overdiagnosis of postoperative urinary retention by bladder scans may lead to unnecessary interventions and delayed discharges. The purpose of this study was to compare the safety of two bladder management protocols following TJA. METHODS From January 3, 2022 to April 29, 2022, 519 consecutive patients operated on by thirteen surgeons underwent routine postoperative bladder scanning (standard protocol). From February 28, 2022 to April 29, 2022, a new protocol was introduced by three surgeons in 209 consecutive patients using a specific algorithm (selective protocol) so that only symptomatic patients had bladder scans. The primary outcome of interest was catheterization rate. Chi-square and Students t-tests were used for analyses. There were 37.7% of patients in the selective group who received scans. RESULTS Times to catheterization, readmissions, emergency department visits, and straight catheterization rates (15.0 versus 14.8% P = .999) were similar. More scans in the selective group resulted in intervention (39.2 versus 15.0%, P < .001). Prevoid volumes were higher in the selective protocol (608 versus 448 mL, P < .001). Postvoid volumes were similar (233 versus 223 mL, P = .497). There was one readmission for a urinary tract infection in the standard group and no urinary-related readmissions in the selective group. CONCLUSION The selective protocol had a higher rate of same day discharge, fewer bladder scans, and did not lead to increased rates of urinary-related complications. These findings suggest that selective bladder scanning for symptomatic patients can be safely instituted for TJA patients.
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Affiliation(s)
- Justin A Magnuson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John R Hobbs
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Virginia Snyder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William J Hozack
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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McDermott CD, Tunitsky-Bitton E, Dueñas-Garcia OF, Willis-Gray MG, Cadish LA, Edenfield A, Wang R, Meriwether K, Mueller ER. Postoperative Urinary Retention. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:381-396. [PMID: 37695249 DOI: 10.1097/spv.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
ABSTRACT This clinical consensus statement on the management of postoperative (<6 weeks) urinary retention (POUR) reflects statements drafted by content experts from the American Urogynecologic Society's POUR writing group. The writing group used a modified Delphi process to evaluate statements developed from a structured literature search and assessed for consensus. After the definition of POUR was established, a total of 37 statements were assessed in the following 6 categories: (1) incidence of POUR, (2) medications, (3) patient factors, (4) surgical factors, (5) urodynamic testing, and (6) voiding trials. Of the 37 original statements, 34 reached consensus and 3 were omitted.
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Affiliation(s)
| | - Elena Tunitsky-Bitton
- Hartford Hospital, Hartford, CT; University of Connecticut School of Medicine, Farmington, CT
| | | | | | | | | | - Rui Wang
- Penn Medicine Princeton Health, Princeton, NJ
| | | | - Elizabeth R Mueller
- Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL
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Choi J, Kim JS, Hyun SJ, Kim KJ, Kim HJ, Deletis V, Park KS. Intraoperative bulbocavernosus reflex monitoring in posterior lumbar fusion surgery. Clin Neurophysiol 2022; 144:59-66. [PMID: 36274572 DOI: 10.1016/j.clinph.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the utility of intraoperative bulbocavernosus reflex (BCR) monitoring in posterior lumbar fusion surgery. METHODS We retrospectively evaluated 153 patients undergoing posterior lumbar fusion with intraoperative BCR monitoring. Voiding function was assessed at discharge and two follow-ups. RESULTS BCR was preserved in 151 patients and completely disappeared in two patients at the end of surgery. For patients in whom BCR was preserved, voiding difficulties at discharge and 1-month and 6-month follow-ups were noted in 16 (10.6%), 9 (6.0%), and 0 (0.0%) patients, respectively. However, patients with BCR loss experienced voiding difficulties at all three time-points. Statistical analysis showed a significant difference in voiding between those with preserved and disappeared BCRs at 6 months postoperatively. BCR disappeared during surgery but recovered before the end of surgery in six patients. Among these patients, one experienced transient voiding difficulties postoperatively but with good recovery. However, the other five patients did not experience postoperative voiding difficulties. CONCLUSIONS BCR had low sensitivity for voiding dysfunction at discharge, but had high accuracy at 6-month follow-up examinations. BCR loss was associated with new voiding dysfunction. SIGNIFICANCE Intraoperative BCR monitoring is a potentially useful tool for enhancing safety during posterior lumbar fusion by predicting postoperative voiding dysfunction.
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Affiliation(s)
- Jongsuk Choi
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia and Albert Einstein College of Medicine, New York, NY, USA
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Overnight removal of urinary indwelling catheter following vaginal prolapse surgery (OVERACT). Eur J Obstet Gynecol Reprod Biol 2022; 279:50-54. [DOI: 10.1016/j.ejogrb.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022]
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Aleman R, Blanco DG, Funes DR, Montorfano L, Semien G, Szomstein S, Lo Menzo E, Rosenthal RJ. Does Transverse Abdominis Plane Block Increase the Risk of Postoperative Urinary Retention after Inguinal Hernia Repair? JSLS 2021; 25:JSLS.2021.00015. [PMID: 34803366 PMCID: PMC8580164 DOI: 10.4293/jsls.2021.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Postoperative urinary retention (POUR) is a common adverse event after inguinal hernia repair (IHR), with an incidence of up to 22.2%. The aim of this study is to determine if pre-operative transverse abdominis plane (TAP) block increases the incidence of POUR. Methods: A retrospective review was performed for all patients who underwent IHR (open or laparoscopic) at this institution, from January 1, 2016 to December 31, 2017. Patients were divided into two groups: Patients that had a TAP block before surgery (group 1) and patients with no TAP block (group 2). Common demographics and comorbidities were collected along with postoperative outcomes and POUR incidence rates for every group to determine procedural influence. Results: From 276 patients reviewed, 28.2% (N = 78) underwent TAP block before surgery. The patient cohort mean age was 61.1 ± 14.4 years. Most the interventions were laparoscopic (81.2%) and an overall POUR incidence rate of 7.6% (N = 21) was observed. Comparatively, common demographics and comorbidities were statistically similar for both groups, with the exception of type 2 diabetes mellitus (p = 0.049). Individually, group 1 and 2 presented POUR incidence rates of 14.1% and 5.05%, respectively. While intraoperative fluid administration, early readmission rate, and length were similar in both groups, there was a significant difference in POUR incidence rates (p = 0.01). Conclusion: Patients undergoing TAP block during IHR might have an increased risk of developing POUR. Further larger, prospective, and randomized controlled studies are necessary to better assess these findings.
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Affiliation(s)
- Rene Aleman
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Gutierrez Blanco
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Romero Funes
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - George Semien
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Samuel Szomstein
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Emanuele Lo Menzo
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
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Wei B, Asban A, Xie R, Sollie Z, Deng L, DeLay TK, Swicord WB, Kumar R, Kirklin JK, Donahue J. A prediction model for postoperative urinary retention after thoracic surgery. JTCVS OPEN 2021; 7:359-366. [PMID: 36003757 PMCID: PMC9390440 DOI: 10.1016/j.xjon.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
Background Urinary retention remains a frequent postoperative complication, associated with patient discomfort and delayed discharge following general thoracic surgery (GTS). We aimed to develop and prospectively validate a predictive model of postoperative urinary retention (POUR) among GTS patients. Methods We retrospectively developed a predictive model using data from the Society of Thoracic Surgeons GTS Database at our institution. The patient study cohort included adults undergoing elective in-patient surgical procedures without a history of renal failure or Foley catheter on entry to the recovery suite (August 2013 to March 2017). Multivariable logistic regression models identified factors associated with urinary retention, and a nomogram to aid medical decision making was developed. The predictive model was validated in a cohort of GTS patients between April 2017 and November 2018 using receiver operating characteristic (ROC) analysis. Results The predictive model was developed from 1484 GTS patients, 284 of whom (19%) experienced postoperative urinary retention within 24 hours of the operation. Risk factors for POUR included older age, male sex, higher preoperative creatinine, chronic obstructive pulmonary disease, primary diagnosis, primary procedure, and use of postoperative patient-controlled analgesia. A logistic nomogram for estimating the risk of POUR was created and validated in 646 patients, 65 of whom (10%) had urinary retention. The ROC curves of development and validation models had similar favorable c-statistics (0.77 vs 0.72; P > .05). Conclusions Postoperative urinary retention occurs in nearly 20% of patients undergoing major GTS. Using a validated predictive model may help by targeting certain patients with prophylactic measures to prevent this complication.
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Choi CI, Kim JK, Choo MS, Lee SH, Chang JD, Han JH. Preventive effects of tamsulosin for postoperative urinary retention after lower limb arthroplasty: A randomized controlled study. Investig Clin Urol 2021; 62:569-576. [PMID: 34387038 PMCID: PMC8421999 DOI: 10.4111/icu.20200523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/12/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This prospective, randomized, controlled study investigated the use of tamsulosin, a selective alpha-blocker, as a prophylactic medication to prevent postoperative urinary retention (POUR) following lower limb arthroplasty. MATERIALS AND METHODS The criterion for diagnosing POUR was used a postoperative bladder volume over 400 mL with incomplete emptying. Patients who underwent primary total hip or knee arthroplasty were randomly assigned at a 1:1 ratio to tamsulosin treatment and non-treatment groups at a single center from September 2018 to November 2018. The treatment group received 0.2 mg of tamsulosin orally once at night for 3 days starting on postoperative day 1. During this 3-day period, an indwelling Foley catheter was maintained. The incidence of POUR according to tamsulosin treatment following lower limb arthroplasty was the primary outcome. RESULTS In total, 100 patients were enrolled, of whom 5 discontinued participation. POUR was diagnosed in 20 of the remaining 95 patients (21.1%). The treatment group contained 48 patients, of whom 6 (12.5%) developed POUR, whereas POUR occurred in the 14 of the 47 patients (29.8%) in the non-treatment group. Tamsulosin treatment reduced the risk of POUR by two-thirds (odds ratio [OR], 0.337; 95% confidence interval [CI], 0.117-0.971; p=0.044). The risk reduction associated with tamsulosin treatment remained robust post-adjustment for potential covariates (OR, 0.250; 95% CI, 0.069-0.905; p=0.038). CONCLUSIONS Tamsulosin administration immediately after lower limb arthroplasty reduced the incidence of urinary retention and diminished the need for long-term catheterization.
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Affiliation(s)
- Chang Il Choi
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong Keun Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Min Soo Choo
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jun-Dong Chang
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jun Hyun Han
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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14
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Jeong HY, Song SG, Lee JK. Predictors of Postoperative Urinary Retention After Semiclosed Hemorrhoidectomy. Ann Coloproctol 2021:ac.2021.00304.0043. [PMID: 34284555 PMCID: PMC8898629 DOI: 10.3393/ac.2021.00304.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/05/2021] [Indexed: 11/02/2022] Open
Abstract
Purpose This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia. Methods This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019. Results Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13-2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14-2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04-1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12-1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57-2.68; P=0.001) than those who did not. Conclusion Male sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.
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Affiliation(s)
| | - Seok Gyu Song
- Department of Surgery, Seoul Songdo Hospital, Seoul, Korea
| | - Jong Kyun Lee
- Department of Surgery, Seoul Songdo Hospital, Seoul, Korea
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15
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Klebanoff JS, Barnes WA, Kazma J, Ingraham CF, Mangini MG, Nishikawa MI, Goldstein NM, Tyan P, Moawad GN. Patterns of voiding following laparoscopic hysterectomy. J Gynecol Obstet Hum Reprod 2021; 50:102126. [PMID: 33775918 DOI: 10.1016/j.jogoh.2021.102126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy. DESIGN Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital. RESULTS 450 minimally invasive hysterectomies were included in the final analysis, 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 min. Based on the 50th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 min) however the difference was not statistically significant (p=.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups. CONCLUSIONS Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 h after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.
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Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Whitney A Barnes
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Caitlin F Ingraham
- Department of Obstetrics and Gynecology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718 - USA
| | - Marissa G Mangini
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Moena I Nishikawa
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Naomi M Goldstein
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA.
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Ceratti RDN, Beghetto MG. Incidence of urinary retention and relations between patient's complaint, physical examination, and bladder ultrasound. ACTA ACUST UNITED AC 2021; 42:e20200014. [PMID: 33886922 DOI: 10.1590/1983-1447.2021.20200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the frequency of urinary complaints, bladder globe, and need for bladder relief catheterization according to ultrasound; to investigate the relationship between the urinary volume estimated by ultrasound and the one drained in catheterization; and to describe the relationship of patient's complaints and detection of bladder globe with the diagnosis of urinary retention. METHOD A cross-sectional study with clinical patients with suspected urinary retention in a tertiary hospital, conducted from February to September 2018. Urinary volume ≥500 mL in ultrasound was considered urinary retention. RESULTS Two hundred and five evaluations were performed in 44 patients. Urinary retention was detected by ultrasound in 33.2% of the evaluations. There was a strong correlation between ultrasound and bladder catheterization. There was a higher frequency of identification of bladder globe in urinary volumes ≥300 mL. CONCLUSION The incidence of urinary retention was higher when ultrasound was used for the diagnosis, when compared to patient's complaint and physical examination. Ultrasound showed to be accurate in establishing urinary volume.
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Affiliation(s)
| | - Mariur Gomes Beghetto
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
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17
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Ahmadi Amoli H, Vaghef Davari F, Rahmanian B, Sharifi A, Shariat Moharari R, Rahimpour E, Rahmanian M, Gooran S. Prophylactic postoperative condom sheet placement: A randomized clinical trial to test a new concept. Ann Med Surg (Lond) 2021; 62:415-418. [PMID: 33552504 PMCID: PMC7858678 DOI: 10.1016/j.amsu.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/02/2021] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Postoperative urinary retention (POUR) is one of the most common complications after surgery with several risk factors. However, its precise etiology is not completely understood. So far, the effect of prophylactic condom sheet placement on the prevention of POUR has not been addressed. This study was designed to understand whether preventive condom sheet decreases the rate of POUR. Materials and methods This randomized clinical trial was carried out in an educational hospital during 2018-2019. All male patients, who underwent anorectal surgery with spinal anesthesia, were included and randomly allocated into two groups (with and without postoperative condom sheet placement). Results A total of 172 patients were included in this study (86 patients per group). Twenty-three (13.4%) patients developed POUR. The incidence of POUR was 15.1% among patients with condom sheets and 11.6% in patients without condom sheets, which was not significantly different (P > 0.5). POUR development had a significant correlation with the use of morphine and history of hypertension in both univariate and multivariate analyses. Conclusion Based on the present results, it seems that condom sheet placement did not effectively prevent POUR in patients; therefore, ambulation of patients after surgery is a more effective strategy for these patients.
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Affiliation(s)
| | - Farzad Vaghef Davari
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Rahimpour
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Gooran
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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de Jong AC, Maaskant JM, Groen LA, van Woensel JBM. Monitoring of micturition and bladder volumes can replace routine indwelling urinary catheters in children receiving intravenous opioids: a prospective cohort study. Eur J Pediatr 2021; 180:47-56. [PMID: 32529397 PMCID: PMC7782390 DOI: 10.1007/s00431-020-03703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/03/2022]
Abstract
In this prospective observational study, the incidence, risk factors and the time to event of urinary retention in children receiving intravenous opioids were evaluated. Urinary retention was confirmed by ultrasound following the inability to void for 8 h or earlier in patients experiencing discomfort. In total, 207 opioid episodes were evaluated, of which 199 (96.1%) concerned morphine, in 187 children admitted to the pediatric ward or pediatric intensive care unit. The median age was 7.6 years (IQR 0.9-13.8), and 123 (59.4%) were male. The incidence of urinary retention was 31/207 (15.0%) opioid episodes, in which 14/32 (43.8%) patients received continuous sedation for mechanical ventilation and 17/175 (9.7%) received no sedation. Multivariable logistic regression analysis showed a significant association with continuous sedation (OR 6.8, 95% CI 2.7-17.4, p 0.001) and highest daily fluid intake (OR 0.8 per 10% deviation of normal intake, 95% CI 0.7-0.9, p 0.01). Opioid dosage, age and gender were not significantly associated. Most events (28/31, 90.3%) occurred within 24 h.Conclusion: The incidence of urinary retention in children receiving intravenous opioids is low, indicating that placement of urinary catheters is not routinely necessary in these patients. However, micturition and bladder volumes must be monitored, especially in sedated children and during the first 24 h of opioid administration. What is Known: • Great variation exists in the routine placement of urinary catheters in children receiving IV opioids. What is New: • Confirmed by ultrasound, the incidence of urinary retention in children receiving intravenous opioids in this study was 15%, indicating that placement of urinary catheters is not routinely necessary in these patients. • Children receiving continuous sedation for invasive mechanical ventilation showed a sevenfold greater risk of developing urinary retention than non-sedated patients.
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Affiliation(s)
- Anita C. de Jong
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Jolanda M. Maaskant
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luitzen A. Groen
- Department of Pediatric Urology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Job B. M. van Woensel
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
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Medairos R, Berger GK, Prebay ZJ, Foss H, O'Connor RC. Post-operative urinary retention (POUR) score – Can incomplete bladder emptying after surgery be predicted? ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pcorm.2020.100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Avondstondt AM, Hidalgo RJ, Salamon CG. Intrapartum risk factors for postpartum urinary retention: a case-control study. Int Urogynecol J 2020; 31:2395-2398. [PMID: 32524158 DOI: 10.1007/s00192-020-04378-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Urinary voiding dysfunction is a common postpartum condition. Increased knowledge of risk factors for postpartum urinary retention could improve early identification of women at risk and lead to enhanced postpartum surveillance. We sought to identify intrapartum factors that contribute to postpartum urinary retention. METHODS This retrospective case-control study compared subjects who developed postpartum urinary retention requiring indwelling catheterization after vaginal delivery to a control group who did not require catheterization. The control group was randomly selected in a 1:4 ratio. Continuous data were analyzed using a two-sample t-test and Mann-Whitney U test. Categorical data were analyzed using Fisher's exact test and two proportions test. Logistic regression was performed to identify variables independently associated with increased risk for development of postpartum urinary retention. RESULTS A total of 5802 women who delivered vaginally met eligibility criteria with 38 women (0.65%) experiencing postpartum urinary retention. Logistic regression revealed that nulliparity, ≥ 2nd-degree obstetrical laceration, and intermittent catheterization during labor were independently associated with increased risk for postpartum urinary retention. CONCLUSION No single factor predicted development of postpartum urinary retention; however, a higher index of suspicion after vaginal delivery is warranted for nulliparous women, ≥ 2nd-degree obstetrical laceration, and if intermittent catheterization during labor was required.
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Affiliation(s)
- Andrea M Avondstondt
- Atlantic Health System Department of Obstetrics, Gynecology and Women's Health, 435 South St #370, Morristown, NJ, 07960, USA.
| | - Ryan J Hidalgo
- University of South Florida Department of Obstetrics and Gynecology, Tampa, FL, USA
| | - Charbel G Salamon
- Atlantic Health System Department of Obstetrics, Gynecology and Women's Health, 435 South St #370, Morristown, NJ, 07960, USA
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Cremins M, Vellanky S, McCann G, Mancini M, Sanzari L, Yannopoulos A. Considering healthcare value and associated risk factors with postoperative urinary retention after elective laminectomy. Spine J 2020; 20:701-707. [PMID: 32006710 DOI: 10.1016/j.spinee.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mitigating common complications such as postoperative urinary retention (POUR) following elective spine surgery is prudent. Identifying patients at risk for POUR and recognizing associated factors, to avoid a more complicated postoperative episode should be a priority and easily achievable. Understanding the financial burden of complications, such as POUR, is also important for value-based healthcare, not only for providers, but for employers and payors as well. PURPOSE The purpose of this study is to examine patient and surgical factors that may lead to increased risk for POUR and its associated cost following elective lumbar laminectomies. STUDY DESIGN/SETTING This is a retrospective study of the incidence of postoperative urinary retention after elective one- and two-level primary lumbar laminectomies. PATIENT SAMPLE We followed patients undergoing one- and two-level primary elective lumbar laminectomies performed between April 2014 and December 2016. OUTCOME MEASURES Patient factors included age, gender, body-mass index, and comorbidities. Surgical factors included surgical time, intraoperative fluid volume requirements, anesthesia type, and surgical levels involved. Other outcome variables included length of stay, discharge disposition, 30-day all-cause readmissions and emergency department visits, 90-day complications, and variable direct costs. METHODS The incidence of POUR was evaluated and compared with patient and surgical factors and cost-specific variables to identify correlations and potential risk for POUR after one- and two-level primary lumbar laminectomies. RESULTS Analysis included 333 patients - 203 one-level laminectomies and 130 two-level laminectomies. The overall incidence of POUR was 17.4%. Age, male gender, and history of urinary retention were significantly associated with POUR. There was a significantly increased risk of POUR with increased surgical time, but not with anesthesia type. There were also no significant differences in body-mass index, other study comorbidities, intraoperative fluid requirements, readmission, emergency department visit, and complication rates between groups. On average, patients with POUR had a significantly longer length of stay than patients without POUR. In addition, more POUR patients were discharged to acute rehabilitation facilities and had higher average variable direct cost compared tonon-POUR patients. CONCLUSIONS POUR is a significant risk after elective laminectomy. This study supports several widely accepted beliefs regarding POUR risk, while challenging others. It also highlights the burden of POUR development after surgery. At our institution, we developed a protocol supported by these findings.
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Affiliation(s)
- Michael Cremins
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Smitha Vellanky
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Grace McCann
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA.
| | - Michael Mancini
- Spine Institute of Connecticut, Saint Francis Hospital and Medical Center, 114 Woodland St, Hartford, CT 06105, USA
| | - Laura Sanzari
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Aris Yannopoulos
- Musculoskeletal Outcomes Institute, Saint Francis Hospital and Medical Center, 114 Woodland St, Hartford, CT 06105, USA
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Huang H, Dong L, Gu L. The timing of urinary catheter removal after gynecologic surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e18710. [PMID: 31914080 PMCID: PMC6959902 DOI: 10.1097/md.0000000000018710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.
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Affiliation(s)
- Hui Huang
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou
| | - Li Dong
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Lan Gu
- Department of Senior Cadres Ward, The First Affiliated Hospital of Soochow University, Suzhou, China
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23
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Does spinal anesthesia lead to postoperative urinary retention in same-day urogynecology surgery? A retrospective review. Int Urogynecol J 2019; 30:1283-1289. [DOI: 10.1007/s00192-019-03893-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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Choi JH, Yoon S, Lee SW, Jeh SU, Hwa JS, Hyun JS, Chung KH, Seo DH, Lee C, Kam SC, Choi SM. Risk factors for postoperative urinary retention among women who underwent laparoscopic cholecystectomy. Low Urin Tract Symptoms 2019; 11:158-162. [DOI: 10.1111/luts.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/10/2018] [Accepted: 01/01/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Jae Hwi Choi
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Sol Yoon
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Sin Woo Lee
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Jeong Seok Hwa
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Ky Hyun Chung
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
| | - Deok Ha Seo
- Department of UrologyGyeongsang National University Changwon Hospital Changwon Republic of Korea
| | - Chunwoo Lee
- Department of UrologyGyeongsang National University Changwon Hospital Changwon Republic of Korea
| | - Sung Chul Kam
- Department of UrologyGyeongsang National University Changwon Hospital Changwon Republic of Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University HospitalGyeongsang National University School of Medicine Jinju Republic of Korea
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Agrawal K, Majhi S, Garg R. Post-operative urinary retention: Review of literature. World J Anesthesiol 2019; 8:1-12. [DOI: 10.5313/wja.v8.i1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/11/2018] [Accepted: 01/05/2019] [Indexed: 02/06/2023] Open
Abstract
Postoperative urinary retention (POUR) is one of the postoperative complications which is often underestimated and often gets missed and causes lot of discomfort to the patient. POUR is essentially the inability to void despite a full bladder in the postoperative period. The reported incidence varies for the wide range of 5%-70%. Multiple factors and etiology have been reported for occurrence of POUR and these depend on the type of anaesthesia, type and duration of surgery, underlying comorbidities, and drugs used in perioperative period. Untreated POUR can lead to significant morbidities such as prolongation of the hospital stay, urinary tract infection, detrusor muscle dysfunction, delirium, cardiac arrhythmias etc. This has led to an increasing focus on early detection of POUR. This review of literature aims at understanding the normal physiology of micturition, POUR and its predisposing factors, complications, diagnosis and management with special emphasis on the role of ultrasound in POUR.
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Affiliation(s)
- Kritika Agrawal
- Department of Onco-Anaesthesia, Palliative Care, All-India Institute of Medical Sciences, Delhi 110029, India
| | - Satyajit Majhi
- Department of Anaesthesiology, Max Super-Speciality Hospital, Delhi 110029, India
| | - Rakesh Garg
- Department of Anaesthesiology, Intensive Care, Pain and Palliative Medicine, All India Institute of Medical Sciences, Delhi 110029, India
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Scott AJ, Mason SE, Langdon AJ, Patel B, Mayer E, Moorthy K, Purkayastha S. Prospective Risk Factor Analysis for the Development of Post-operative Urinary Retention Following Ambulatory General Surgery. World J Surg 2019; 42:3874-3879. [PMID: 29947990 PMCID: PMC6244976 DOI: 10.1007/s00268-018-4697-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims Post-operative urinary retention (POUR) is a common cause of unplanned admission following day-case surgery and has negative effects on both patient and surgical institution. We aimed to prospectively evaluate potential risk factors for the development of POUR following day-case general surgical procedures. Methods Over a 24-week period, consecutive adult patients undergoing elective day-case general surgery at a single institution were prospectively recruited. Data regarding urinary symptoms, comorbidities, drug history, surgery and perioperative anaesthetic drug use were collected. The primary outcome was the incidence of POUR, defined as an impairment of bladder voiding requiring either urethral catheterisation, unplanned overnight admission or both. Potential risk factors for the development of POUR were analysed by logistic regression. Results A total of 458 patients met the inclusion criteria during the study period, and data were collected on 382 (83%) patients (74.3% male). Sixteen patients (4.2%) experienced POUR. Unadjusted analysis demonstrated three significant risk factors for the development of POUR: age ≥ 56 years (OR 7.77 [2.18–27.78], p = 0.002), laparoscopic surgery (OR 3.37 [1.03–12.10], p = 0.044) and glycopyrrolate administration (OR 5.56 [2.00–15.46], p = 0.001). Male sex and lower urinary tract symptoms were not significant factors. Multivariate analysis combining type of surgery, age and glycopyrrolate use revealed that only age ≥ 56 years (OR 8.14 [2.18–30.32], p = 0.0018) and glycopyrrolate administration (OR 3.48 [1.08–11.24], p = 0.0370) were independently associated with POUR. Conclusions Patients aged at least 56 years and/or requiring glycopyrrolate—often administered during laparoscopic procedures—are at increased risk of POUR following ambulatory general surgery. Electronic supplementary material The online version of this article (10.1007/s00268-018-4697-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A J Scott
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK. .,Faculty of Medicine, Imperial College London, London, UK.
| | - S E Mason
- Faculty of Medicine, Imperial College London, London, UK
| | | | - B Patel
- Department of Otolaryngology, Northwick Park Hospital, London, UK
| | - E Mayer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - K Moorthy
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - S Purkayastha
- St Mary's Hospital, Imperial College Healthcare NHS Trust, 10th Floor QEQM, London, W2 1NY, UK.,Faculty of Medicine, Imperial College London, London, UK
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Aiyer SN, Kumar A, Shetty AP, Kanna RM, Rajasekaran S. Factors Influencing Postoperative Urinary Retention Following Elective Posterior Lumbar Spine Surgery: A Prospective Study. Asian Spine J 2018; 12:1100-1105. [PMID: 30322244 PMCID: PMC6284120 DOI: 10.31616/asj.2018.12.6.1100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/17/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective observational study. Purpose To determine the incidence of postoperative urinary retention (POUR) in patients undergoing elective posterior lumbar spine surgery and identify the risk factors associated with the development of POUR. Overview of Literature POUR following surgery can lead to detrusor dysfunction, urinary tract infections, prolonged hospital stay, and a higher treatment cost; however, the risk factors for POUR in spine surgery remain unclear. Methods A prospective, consecutive analysis was conducted on patients undergoing elective posterior lumbar surgery in the form of lumbar discectomy, lumbar decompression, and single-level lumbar fusions during a 6-month period. Patients with spine trauma, preoperative neurological deficit, previous urinary disturbance/symptoms, multiple-level fusion, and preoperative catheterization were excluded from the study. Potential patient- and surgery-dependent risk factors for the development of POUR were assessed. Univariate analysis and a multiple logistical regression analysis were performed. Results A total of 687 patients underwent posterior lumbar spine surgery during the study period; among these, 370 patients were included in the final analysis. Sixty-one patients developed POUR, with an incidence of 16.48%. Significant risk factors for POUR were older age, higher body mass index (BMI), surgery duration, intraoperative fluid administration, lumbar fusion versus discectomy/ decompression, and higher postoperative pain scores (p<0.05 for all). Sex, diabetes, and the type of inhalational agent used during anesthesia were not significantly associated with POUR. Multiple logistical regression analysis, including age, BMI, surgery duration, intraoperative fluid administration, fusion surgery, and postoperative pain scores demonstrated a predictive value of 92% for the study population and 97% for the POUR group. Conclusions POUR was associated with older age, higher BMI, longer surgery duration, a larger volume of intraoperative fluid administration, and higher postoperative pain scores. The contribution of postoperative pain scores in the multiple regression analysis was a significant predictor of POUR.
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Affiliation(s)
| | - Ajit Kumar
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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Golubovsky JL, Ilyas H, Chen J, Tanenbaum JE, Mroz TE, Steinmetz MP. Risk factors and associated complications for postoperative urinary retention after lumbar surgery for lumbar spinal stenosis. Spine J 2018; 18:1533-1539. [PMID: 29447854 DOI: 10.1016/j.spinee.2018.01.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/02/2018] [Accepted: 01/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative urinary retention (POUR) is a very common postoperative complication of all surgeries (5%-70%) that may lead to complications such as urinary tract infection (UTI), bladder overdistension, autonomic dysregulation, and increased postoperative length of stay (LOS). Within the field of spine surgery, the reported incidence rate of POUR is highly variable (5.6%-38%). Lack of clear stratification of surgical level, spinal pathology, and inadequate sample size are major limitations of available studies concerning POUR following spine surgery, which may lead to inconsistency in the incidence of POUR and the ability to model its occurrence and consequences. PURPOSE This study examines the incidence, predictive factors, and complications of POUR in patients undergoing elective posterior lumbar decompression with or without fusion for lumbar stenosis to eliminate bias from studying procedures done in different anatomical regions and with different approaches. Additionally, this study intends to identify the consequences of POUR. STUDY DESIGN AND SETTING A retrospective consecutive cohort analysis was performed to examine patients undergoing posterior lumbar decompression who did and did not develop POUR. PATIENT SAMPLE All patients undergoing posterior lumbar decompression with or without fusion for lumbar stenosis with claudication from January 2014 through December 2015 at our institution were evaluated. Patients under the age of 18 and patients with spinal malignancies or infections were excluded. OUTCOME MEASURES Physiological measures included identification of POUR by evidence of reinsertion of a Foley catheter, use of straight catheterization postoperatively, or by a clear medical diagnosis with pharmacologic treatment. Other physiological measures included identification of development of UTI, sepsis, acute kidney injury (AKI), surgical site infection (SSI), or readmission within 90 days after surgery, as well as LOS and discharge disposition. METHODS The electronic medical record was searched for all patients meeting inclusion and exclusion criteria. Postoperative urinary retention was defined as reinsertion of a Foley catheter, use of straight catheterization postoperatively, or a clear medical diagnosis with pharmacologic treatment. Statistical analysis was performed in R statistical software package version 3.3.2. Multiple variable selection techniques were used to determine appropriate variables for regression models, and logistic models were fit to the development of POUR and postoperative complications, whereas a linear regression model was used for LOS. RESULTS Data were collected on 1,592 consecutive patients. Among the sample population, the mean age at surgery was 67 (standard deviation 10.1) and 45% of patients were women. The incidence rate of POUR was 17.1% (273/1592). Increased age (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.02-1.06; p<.001), benign prostatic hyperplasia (BPH) (OR=1.92; 95% CI, 1.32-2.78); p<.001), previous AKI (OR=3.29; 95% CI, 1.11-9.29; p=.025), and previous UTI (OR=1.69; 95% CI, 1.24-2.24; p<.001) significantly increased the probability of developing POUR. Factors including increased body mass index, coronary artery disease, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, tobacco use, and fusion were found to be non-significant and were excluded from the model. With respect to complications, POUR was found to be associated with development of UTI (OR=4.50; 95% CI, 3.14-6.45; p<.001), sepsis (OR=4.05; 95% CI, 1.16-13.55; p=.022), increased LOS (p<.001), increased likelihood to be discharged to a skilled nursing facility (SNF) (OR of discharge to home=0.44; 95% CI, 0.32-0.62; p<.001), and increased risk of readmission within 90 days of the index surgery (OR=1.60; 95% CI, 1.11-2.26; p=.009). Development of POUR did not increase the risk of developing AKI (OR=2.45; 95% CI, 0.93-6.30; p=.063) or a SSI (OR=1.09; 95% CI, 0.56-2.02; p=.79). CONCLUSIONS Overall, POUR was a significant risk factor for the development of UTI, sepsis, increased LOS, discharge to a SNF, and readmission within 90 days. Surgeons and anesthesiologists should take preventative measures against POUR in individuals with increased age, BPH, AKI, and UTI within 90 days before surgery, as these factors were found to significantly increase the risk of POUR.
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Affiliation(s)
- Joshua L Golubovsky
- Center for Spine Health, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, 9980 Carnegie Ave, Cleveland, OH 44195, USA.
| | - Haariss Ilyas
- Department of Orthopaedic Surgery, Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jinxiao Chen
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 2109 Adelbert Rd, Cleveland, OH 44106, USA
| | - Joseph E Tanenbaum
- Department of Epidemiology and Biostatistics, Center for Spine Health, Cleveland Clinic, Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA
| | - Thomas E Mroz
- Department of Orthopaedic Surgery, Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Michael P Steinmetz
- Department of Neurological Surgery, Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Into the void: a review of postoperative urinary retention after minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 30:260-266. [DOI: 10.1097/gco.0000000000000465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fekete Z, Kőrösi S, Pajor L, Bajory Z, Németh G, Kozinszky Z. Does anchoring vaginal mesh increase the potential for correcting stress incontinence? BMC Urol 2018; 18:53. [PMID: 29855312 PMCID: PMC5984302 DOI: 10.1186/s12894-018-0363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/11/2018] [Indexed: 11/22/2022] Open
Abstract
Background This study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the mid-urethra to correct an anterior compartment POP–Quantification stage II–III (Q II–III) and concomitant genuine SUI. Methods We analysed clinical data from 248 patients with stage II–III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2008 and June 2010. One hundred and twenty-four women treated with anterior colporrhaphy and 62 patients implanted with a conventional permanent TVM were selected as historical matched controls. Sixty-two patients received a modified permanent TVM, where the mesh was fixed to the mid-urethra with two stitches for the purpose of potentially correcting SUI. Surgical complications were classified using the Clavien–Dindo (CD) classification system. Results The anti-SUI efficacy was minimally higher in the mTVM group than in the original TVM group (p = 0.44, 96.8% vs 91.9%, respectively), while prosthesis surgery was more effective than anterior colporrhaphy in improving the anterior compartment POP–Q status (96.8, 90.3% vs 64.5%, respectively). Anchoring the mesh did not increase the extrusion rate (p = 0.11). The de novo urge symptoms were not more prevalent among those who had received additional periurethral stitches (p = 1.00, 11.3% vs 12.9%). The incidence of reoperation observed in the mTVM group was non-significantly lower than that in the TVM group (p = 0.15, 6.5% vs 16.1%); however, the difference did not reach the level of significance. The early postoperative complication profile was more favourable among the mTVM patients (classified as CD I: 8.1%; CD II: 1.6%; and CD IIIb: 1.6%) as compared to the TVM group (p = 0.013). Conclusions The new, modified mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications.
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Affiliation(s)
- Zoltán Fekete
- Department of Urology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary. .,Department of Obstetrics and Gynaecology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary.
| | - Szilvia Kőrösi
- Department of Obstetrics and Gynaecology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary
| | - László Pajor
- Department of Urology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary
| | - Zoltán Bajory
- Department of Urology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary
| | - Gábor Németh
- Department of Obstetrics and Gynaecology, University of Szeged, Hungary, Semmelweis u. 1, Szeged, H-6725, Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
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31
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Brouwer TA, van den Boogaard C, van Roon EN, Kalkman CJ, Veeger N. Non-invasive bladder volume measurement for the prevention of postoperative urinary retention: validation of two ultrasound devices in a clinical setting. J Clin Monit Comput 2018. [PMID: 29516310 PMCID: PMC6209055 DOI: 10.1007/s10877-018-0123-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the ‘pre-scan’ option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann’s two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by + 17.5% (95% CI + 8.8 to + 26.3%). The Prime® without pre-scan underestimated by − 4.1% (95% CI − 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by − 6.3% (95% CI − 11.6 to − 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®—with and without pre-scan—were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.
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Affiliation(s)
- Tammo A. Brouwer
- Department of Anaesthesiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Charina van den Boogaard
- Institute for Science, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Eric N. van Roon
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Cor J. Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nic Veeger
- Clinical Epidemiologist, Department of Epidemiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
- Department of Epidemiology, University Medical Center, Groningen, The Netherlands
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Schettini DA, Freitas FG, Tomotani DY, Alves JC, Bafi AT, Machado FR. Incidence and risk factors for urinary retention in critically ill patients. Nurs Crit Care 2018; 24:355-361. [PMID: 29430778 DOI: 10.1111/nicc.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/24/2017] [Accepted: 01/15/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Daniel A Schettini
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Flávio Gr Freitas
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Daniere Yv Tomotani
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Jane Cd Alves
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Antonio T Bafi
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil
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Cha JE, Park SW, Choi YI, Oh ID, Kang HY, Lee SH, Choi JH. Sugammadex use can decrease the incidence of post-operative urinary retention by avoiding anticholinergics: a retrospective study. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.1.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jung-Eun Cha
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Wook Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
| | - Young In Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
| | - In Duk Oh
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Hyub Lee
- Department of Urology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea
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Han CS, Kim S, Radadia KD, Zhao PT, Elsamra SE, Olweny EO, Weiss RE. Comparison of Urinary Tract Infection Rates Associated with Transurethral Catheterization, Suprapubic Tube and Clean Intermittent Catheterization in the Postoperative Setting: A Network Meta-Analysis. J Urol 2017; 198:1353-1358. [PMID: 28736320 DOI: 10.1016/j.juro.2017.07.069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE We performed a network meta-analysis of available randomized, controlled trials to elucidate the risks of urinary tract infection associated with transurethral catheterization, suprapubic tubes and intermittent catheterization in the postoperative setting. MATERIALS AND METHODS PubMed®, EMBASE® and Google Scholar™ searches were performed for eligible randomized, controlled trials from January 1980 to July 2015 that included patients who underwent transurethral catheterization, suprapubic tube placement or intermittent catheterization at the time of surgery and catheterization lasting up to postoperative day 30. The primary outcome of comparison was the urinary tract infection rate via a network meta-analysis with random effects model using the netmeta package in R 3.2 (www.r-project.org/). RESULTS Included in analysis were 14 randomized, controlled trials in a total of 1,391 patients. Intermittent catheterization and suprapubic tubes showed no evidence of decreased urinary tract infection rates compared to transurethral catheterization. Suprapubic tubes and intermittent catheterization had comparable urinary tract infection rates (OR 0.903, 95% CI 0.479-2.555). On subgroup analysis of 10 randomized, controlled trials with available mean catheterization duration data in a total of 928 patients intermittent catheterization and suprapubic tube were associated with significantly decreased risk of urinary tract infection compared to transurethral catheterization when catheterization duration was greater than 5 days (OR 0.173, 95% CI 0.073-0.412 and OR 0.142, 95% CI 0.073-0.276, respectively). CONCLUSIONS Transurethral catheterization is not associated with an increased urinary tract infection risk compared to suprapubic tubes and intermittent catheterization if catheterization duration is 5 days or less. However, a suprapubic tube or intermittent catheterization is associated with a lower rate of urinary tract infection if longer term catheterization is expected in the postoperative period.
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Affiliation(s)
- Christopher S Han
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Kushan D Radadia
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Philip T Zhao
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ephrem O Olweny
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert E Weiss
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Frost FS, Fan Y, Harrison A, Modlin T, Samuel S, Thompson N, Katzan I. Failed Removal of Indwelling Urinary Catheters in Patients With Acute Stroke: Incidence and Risk Factors. PM R 2017; 10:160-167. [PMID: 28694220 DOI: 10.1016/j.pmrj.2017.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 03/03/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients who need IUCs have them, and patients who do not need them will have them removed safely, with the goal of reducing medical complications and facilitating the rehabilitation phase of care. OBJECTIVE To determine the incidence of failed removal of IUCs and the factors associated with failed removal in persons hospitalized with acute stroke. DESIGN Retrospective review of medical records and associated clinical data collection platforms. SETTING Comprehensive stroke center at a tertiary care hospital. PATIENTS The study cohort included 175 stroke patients admitted to the hospital and managed with IUCs. Mean age was 66.1 years (standard deviation = 15), 55% were female. METHODS Univariable and multiple logistic regression analyses were performed. Variables assessed included age, gender, race, duration of hospital stay, stroke subtype, National Institutes of Health Stroke Scale, and 6-Clicks Scale, which is a measure of functional status. MAIN OUTCOME MEASUREMENTS The dependent variable was occurrence of a failed attempt at removal of an IUC, defined as removal followed by a catheter reinsertion. RESULTS During the study period, 175 of 432 patients with acute hospital admission for new stroke had an IUC removal event. Of these patients, 46 (26%) experienced a failed catheter removal. On univariate analysis, factors significantly associated with failed removal included presence of a hemorrhagic stroke (P = .005), lower level of physical function (by 6-Clicks and NIHSS scores), hospital length of stay (P < .001), and discharge location (P = .005). Bedside bladder ultrasound testing by nursing staff was used more frequently in the group of patients who had unsuccessful IUC removals (95% confidence interval 4.56-21.67, P < .001). Length of stay (P < .001), white race (P = .001), and hemorrhagic stroke (P = .009) were associated independently with failed catheter removal after adjustment for other clinical variables. CONCLUSIONS This single-site study identified a high incidence of failed urinary catheter removal in patients with stroke, along with factors associated with failed removal. This is the first step in developing a predictive model that could reduce the incidence of this adverse event. Policies, penalties, and protocols designed to reduce catheter days must be sensitive to the special situations in which IUCs are medically necessary and equal consideration given to identifying the patients for which catheter removal poses a greater risk than continued catheter use. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frederick S Frost
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Youran Fan
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Alexander Harrison
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Trey Modlin
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Susan Samuel
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Nicholas Thompson
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Irene Katzan
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
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Blackwell RH, Vedachalam S, Shah AS, Kothari AN, Kuo PC, Gupta GN, Turk TMT. Postoperative Urinary Retention is an Independent Predictor of Short-Term and Long-Term Future Bladder Outlet Procedure in Men. J Urol 2017. [PMID: 28624526 DOI: 10.1016/j.juro.2017.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Postoperative urinary retention is a common complication across surgical specialties. To our knowledge no literature to date has examined postoperative urinary retention as a predictor of long-term receipt of surgery for bladder outlet obstruction. MATERIALS AND METHODS We retrospectively reviewed the records of inpatients who underwent nonurological surgery in California between 2008 and 2010. Postoperative urinary retention during the index admission was identified, as was receipt of a bladder outlet procedure (transurethral prostate resection, prostate photoselective vaporization or suprapubic prostatectomy) at a subsequent encounter. Patients were matched using propensity scoring of demographics, comorbidities and surgery type. Adjusted Kaplan-Meier analysis was performed to determine the cumulative incidence of subsequent bladder outlet procedures by patient group, including group 1-age 60 years or greater and postoperative urinary retention, group 2-age 60 years or greater and no postoperative urinary retention, group 3-age less than 60 years and postoperative urinary retention, and group 4-age less than 60 years and no postoperative urinary retention. RESULTS Of 769,141 eligible male patients postoperative urinary retention developed in 8,051 (1.1%). Following hospital discharge 1,855 patients (0.24%) underwent a bladder outlet procedure. Those treated with a bladder outlet procedure were significantly more likely to have experienced postoperative urinary retention during the index admission (6.3% vs 1.0%, p <0.001). On matched analysis the bladder outlet procedure rate at 3 years was 7.1%, 2.2%, 0.8% and 0.0% in groups 1, 2, 3 and 4, respectively. CONCLUSIONS In men 60 years old or older postoperative urinary retention identified those with an increased incidence of bladder outlet procedures within 3 years. Men younger than 60 years had a low rate of subsequent bladder outlet procedures regardless of a postoperative urinary retention diagnosis.
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Affiliation(s)
- Robert H Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, Illinois; One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois.
| | - Srikanth Vedachalam
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois; Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois
| | - Arpeet S Shah
- Department of Urology, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois
| | - Anai N Kothari
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois
| | - Paul C Kuo
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois; One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, Illinois; Surgical Services, Edward Hines Jr. Veterans Administration Medical Center, Hines, Illinois
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Lee S, Kim CH, Chung CK, Park SB, Yang SH, Kim SH, Kang S, Lee JH, Choi Y. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis. Spine J 2017; 17:469-477. [PMID: 27012647 DOI: 10.1016/j.spinee.2016.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/25/2016] [Accepted: 03/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients. PURPOSE The aim of the present study was to determine the incidence of and risk factors for POUR. STUDY DESIGN/SETTING This is a retrospective nested case-control study. PATIENT SAMPLE A total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed. OUTCOME MEASURES A multivariable logistic model was utilized to identify risk factors. METHODS A systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4-6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100 mL for more than 2 days after surgery. RESULTS The incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029-1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001-1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684). CONCLUSION POUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries.
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Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, 875 haeun-daero, Haeundae-gu, Busan, 612-896, South Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Neuroscience Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE
| | - Soo Hyun Kim
- Department of Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soohee Kang
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ju Hee Lee
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Altschul D, Kobets A, Nakhla J, Jada A, Nasser R, Kinon MD, Yassari R, Houten J. Postoperative urinary retention in patients undergoing elective spinal surgery. J Neurosurg Spine 2017. [DOI: org/10.3171/2016.8.spine151371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE
Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence.
METHODS
The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis.
RESULTS
Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome.
CONCLUSIONS
Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.
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Use of bladder volume measurement assessed with ultrasound to predict postoperative urinary retention. North Clin Istanb 2017; 3:209-216. [PMID: 28275753 PMCID: PMC5336626 DOI: 10.14744/nci.2016.03164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/16/2016] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spinal anesthesia. Ultrasound (US) is a simple, non-invasive method to estimate bladder volume before and after surgery. Primary aim of the present study was to investigate utility of bladder volume measured before and after surgery in prediction of POUR risk. Secondary aim was to investigate necessity of urethral catheter use and risk of urethral catheter-related infections. METHODS Eighty patients who received spinal anesthesia for arthroscopic knee surgery were included in the study. Level and duration of sensory and motor block; bladder volume measured preoperatively, in post-anesthetic care unit (PACU), and when discharged from PACU; use of urethral catheter; and incidence of urinary tract infection data were recorded. RESULTS POUR was observed in 28.7% of patients. Length of time for sensory block regression was significantly shorter in patients without POUR (p=0.012). Spontaneous urination was not observed in 3 of 23 patients with POUR, although bladder volume was less than 600 mL. Bladder volume over 600 mL without urination was recorded in 20 patients. There was no statistical difference in preoperative bladder volume between patients who did or did not develop POUR. Bladder volume on admission to PACU was higher in patients with POUR (p=0.023). Urgency and dysuria were observed in 5 patients who required urethral catheterization during postoperative period. Urinary tract infection developed in 1 patient. There was no statistical difference in development of urinary tract infection between patient groups who did and did not undergo urethral catheterization. CONCLUSION Assessment of patient bladder volume with US before arthroscopic knee surgery may be used to foresee development of POUR. Avoiding elective urinary catheterization may reduce urinary infections.
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Abstract
Urinary retention is an important and potentially avoidable postoperative complication. Identifying risk factors for retention is important given expedient bladder decompression is important for long-term outcomes. Age, benign prostatic hyperplasia, and lower urinary tract symptoms are patient factors that predispose to retention. Surgery-related factors include operative time, intravenous fluid administration, type of anesthesia, and procedure type. The mainstay for treatment in the acute setting is Foley catheter placement. Starting alpha-blockers in men is also indicated as they increase voiding trial success. Long-term solutions for chronic retention include a variety of surgeries, with transurethral prostatectomy as the gold standard.
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Affiliation(s)
- Urszula Kowalik
- University of Vermont Medical Center, 111 Colchester Avenue, Mailstop 222WP2, Burlington, VT 05401, USA
| | - Mark K Plante
- Division of Urology, Department of Surgery, University of Vermont Medical Center, University of Vermont College of Medicine, 111 Colchester Avenue, Mailstop 320FL4, Burlington, VT 05401, USA.
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Altschul D, Kobets A, Nakhla J, Jada A, Nasser R, Kinon MD, Yassari R, Houten J. Postoperative urinary retention in patients undergoing elective spinal surgery. J Neurosurg Spine 2016; 26:229-234. [PMID: 27767680 DOI: 10.3171/2016.8.spine151371] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.
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Affiliation(s)
- David Altschul
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Andrew Kobets
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Jonathan Nakhla
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Ajit Jada
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Rani Nasser
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Merritt D Kinon
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - Reza Yassari
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and
| | - John Houten
- Marcus Neuroscience Institute, Boca Raton, Florida
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Mason SE, Scott AJ, Mayer E, Purkayastha S. Patient-related risk factors for urinary retention following ambulatory general surgery: a systematic review and meta-analysis. Am J Surg 2016; 211:1126-34. [DOI: 10.1016/j.amjsurg.2015.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 11/26/2022]
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Fligou F, Kallidonis P, Flaris N, Al-Aown A, Kyriazis I, Vasilas M, Panagopoulos V, Perimenis P, Liatsikos E, Vrettos T. Deep sedation in GreenLight laser prostatectomy. Urol Ann 2016; 8:203-7. [PMID: 27141193 PMCID: PMC4839240 DOI: 10.4103/0974-7796.177195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). Patients and Methods: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded. Results: The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 μg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 μcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients. Conclusion: The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The “deep sedation” provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP.
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Affiliation(s)
- Fotini Fligou
- Department of Anesthesiology, University of Patras, Greece
| | | | | | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia
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Hu Y, Craig SJ, Rowlingson JC, Morton SP, Thomas CJ, Persinger MB, Isbell J, Lau CL, Kozower BD. Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial. J Cardiothorac Vasc Anesth 2016; 28:1302-6. [PMID: 25281046 DOI: 10.1053/j.jvca.2014.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal. DESIGN This study described a prospective trial instituting an early urinary catheter removal protocol compared with a historic control group of patients. SETTING The protocol was instituted at a single, academic thoracic surgery unit. PARTICIPANTS The study group was comprised of patients undergoing surgery requiring thoracotomy who received an intraoperative epidural for postoperative pain control. INTERVENTIONS An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound and treated with recatheterization. MEASUREMENTS AND MAIN RESULTS The primary outcomes were urinary retention rate, defined as bladder volume>400 mL, and urinary tract infection rate. Results were compared with a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively enrolled patients, urinary retention rate was higher (26.7% v 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% v 3.8%, p = 0.280). CONCLUSIONS Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.
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Affiliation(s)
- Yinin Hu
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Sarah J Craig
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - John C Rowlingson
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Steve P Morton
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Christopher J Thomas
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Matthew B Persinger
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - James Isbell
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA; Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Christine L Lau
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Benjamin D Kozower
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
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Ronca AE, Baker ES, Bavendam TG, Beck KD, Miller VM, Tash JS, Jenkins M. Effects of sex and gender on adaptations to space: reproductive health. J Womens Health (Larchmt) 2015; 23:967-74. [PMID: 25401943 DOI: 10.1089/jwh.2014.4915] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In this report, sex/gender research relevant to reproduction on Earth, in conjunction with the extant human and animal observations in space, was used to identify knowledge gaps and prioritize recommendations for future sex- and gender-specific surveillance and monitoring of male and female astronauts. With overall increased durations of contemporary space missions, a deeper understanding of sex/gender effects on reproduction-related responses and adaptations to the space environment is warranted to minimize risks and insure healthy aging of the men and women who travel into space.
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Affiliation(s)
- April E Ronca
- 1 Space Biosciences Research Branch, NASA Ames Research Center , Mountainview, California
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Postoperative bladder catheterization based on individual bladder capacity: a randomized trial. Anesthesiology 2015; 122:46-54. [PMID: 25371036 DOI: 10.1097/aln.0000000000000507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Untreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient's own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization. METHODS Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization. RESULTS The average MBC in the control group was 582 ml (±199 ml) and in the index group 611 ml (±209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group. CONCLUSIONS In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.
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What are the risk factors associated with urinary retention after orthopaedic surgery? BIOMED RESEARCH INTERNATIONAL 2015; 2015:613216. [PMID: 25789322 PMCID: PMC4348600 DOI: 10.1155/2015/613216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/23/2022]
Abstract
This study investigates the overall rate of urinary retention in a large cohort of unselected orthopaedic patients who had either general or regional anesthesia and defines the risk factors for postoperative urinary retention in that cohort of patients. A total of 15,681 patients who underwent major orthopaedic surgery with general or spinal/epidural anesthesia were included. Postoperative urinary retention was defined as any patient who required a postoperative consultation to the urologic department regarding voiding difficulty. Age at surgery, sex, type of surgery, medical history including hypertension and diabetes mellitus, and type of anesthesia were analyzed as potential predictor variables. There were 365 postoperative patients who required urology consults for urinary retention (2.3%). Older age at surgery (OR, 1.035; P < 0.0001), male sex (OR, 1.522; P = 0.0004), type of surgery (OR, 1.506; P = 0.0009), history of hypertension (OR, 1.288; P = 0.0436), and history of diabetes mellitus (OR, 2.038; P < 0.0001) were risk factors for urinary retention after orthopaedic surgery. Advanced age, male sex, joint replacement surgery, history of hypertension, and diabetes mellitus significantly increased the risk of urinary retention. In patients with these risk factors, careful postoperative urological management should be performed.
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Zhao S, Meng FJ, Jin YH, Ma Y, Li WW, Mi X. Non-drug conservative treatments for acute urinary retention after surgery in adults. Hippokratia 2015. [DOI: 10.1002/14651858.cd011508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sai Zhao
- Tianjin University of TCM; Postgraduate College; West Anshan Road, no. 312 Tianjin China
| | - Fan Jie Meng
- Tianjin University of TCM; The Nursing College; West Anshan Road, no. 312 Tianjin China 300193
| | - Ying Hui Jin
- Tianjin University of Traditional Chinese Medicine; Nursing; #312 West Anshan Road Tianjin China
| | - Yue Ma
- Tianjin University of TCM; Postgraduate College; West Anshan Road, no. 312 Tianjin China
| | - Wen Wen Li
- Tianjin University of TCM; Postgraduate College; West Anshan Road, no. 312 Tianjin China
| | - Xun Mi
- Jiangsu Province Hospital / The First Affiliated Hospital of Nanjing Medical University; Rehabilitation Medicine Center; Nanjing road no. 300 in Guangzhou Nanjing JiangSu China 210000
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Kim KW, Lee JI, Kim JS, Lee YJ, Choi WJ, Jung H, Park KY, Park CH, Son KH. Risk factors for urinary retention following minor thoracic surgery. Interact Cardiovasc Thorac Surg 2015; 20:486-92. [DOI: 10.1093/icvts/ivu445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Electroacupuncture for bladder function recovery in patients undergoing spinal anesthesia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:892619. [PMID: 25610486 PMCID: PMC4290146 DOI: 10.1155/2014/892619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/10/2014] [Indexed: 02/07/2023]
Abstract
Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function. Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary endpoints included time to spontaneous micturition, voided volume, and adverse events. Results. All patients (31 in electroacupuncture group and 30 in control group) completed the evaluation. During postoperative follow-up, patients in electroacupuncture group presented a significant lower proportion of bladder overdistension than counterparts in control group (16.1% versus 53.3%, P < 0.01). However, no significant difference was found in incidence of postoperative urinary retention between the two groups (0% versus 6.7%, P > 0.05). Furthermore, a shorter time to spontaneous micturition was found in electroacupuncture group compared to control group (228 min versus 313 min, P < 0.001), whereas urine volume and adverse events had no significant difference between the two groups. Conclusions. Electroacupuncture reduced the proportion of bladder overdistension and shortened the time to spontaneous micturition in patients undergoing spinal anesthesia. Electroacupuncture may be a therapeutic strategy for postanesthetic bladder dysfunction.
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