Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

Abstract

BackgroundPostoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease.MethodsWe included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation.ResultsThere were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01).ConclusionsTo avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Post-Operative Urinary Retention (Pour) in Lumbar Spine Surgery- A Prospective Study

“…However, few studies have assessed POUR with lumbar spine surgery. (5,11) Our study documented a rate of 16.5% occurrence of POUR in patients who underwent spinal surgery which is considerably higher than previous reports on POUR in spine surgery, such as that by Atschulet al (5) (8.8%), Gandhi et al (4) (5.6%), and Jung et al (11) (11.1%).…”

“…(1,2,3,6,5) These variations can be attributed to the several factors, including the variable definitions used to define POUR, type of surgery performed, type of anaesthesia, and use of opioid analgesia that affects bladder function. (1,9,10,7,11) Another contributing factor to the variable incidence rates is the fact that variable definitions have been used in these studies to establish POUR. The present study used a clinical definition for defining POUR, and this may be a limitation, particularly in the case of obese patients.…”

“…(1,10,4,11) In contrast, Altschul et al (5) retrospectively reported on 397 elective spine surgery procedures, including cervical, thoracic, and lumbar surgical procedures to report that diabetes mellitus was not an independent risk factor. Similar findings were reported by Hollman et al Limited studies have examined POUR in spine surgery; Jung et al (11) reported on 325 patients undergoing anterior cervical spine surgery for cervical radiculopathy and myelopathy. The authors concluded that older age, diabetes, male sex, BPH, clinical presentation of myelopathy, and narcotic drug use were associated with a higher risk of POUR.…”

Effects of Intraoperative Anesthetic Medications on Postoperative Urinary Retention After Single-Level Lumbar Fusion

“…Major risk factors included male sex, advanced age, BPH, myelopathy, and the use of meperidine. 9 Both studies suggested that the incidence of POUR may be associated with longer length of hospitalization. However, these previous studies were limited in their methodology by focusing primarily on postoperative pain medications as opposed to a variety of intraoperative medications.…”

“…[4][5][6] However, the data is limited in the context of spinal procedures. [7][8][9] Several studies have investigated POUR following spinal procedures. However, these studies have focused on non-modifiable demographic risk factors such as gender and age.…”