Postoperative urinary retention in patients undergoing elective spinal surgery

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Risk factors for postoperative urinary retention among women who underwent laparoscopic cholecystectomy

“…The rate of occurrence of POUR among female patients in this study was 2.9%. This is similar to the rate reported in many previous studies, even though the incidence of POUR for other types of operations has been reported as being lower among female than male patients . Generally, it is known that administering an alpha‐blocker reduces the risk of POUR .…”

“…Similarly, Huang et al suggested that age is a significant risk factor for POUR in their study of 314 patients who underwent TKA (HR 1.33, P < 0.001). In univariate analyses of 397 patients and 205 patients who underwent spinal surgery, Altschul et al and Lee et al found significant differences in age between the POUR and non‐POUR groups ( P = 0.002 for the study of Altschul et al and P = 0.001 for the study of Lee et al). However, neither study found such a significant relationship when retrospective multivariate analysis was used .…”

“…POUR usually develops more in males (10%‐60%) than females (10%‐40%), but depends on the type of operation and anesthesia. Given these results, prior researchers perceived being male as a risk factor for the development of POUR . With regard to the type of anesthesia, the occurrence of POUR is higher for spinal than general anesthesia (24%‐55% vs. 9%‐25%, respectively, and the longer the duration of the surgery, the more likely it is that POUR will occur …”

“…Previous studies have indicated that POUR is caused by a failure of the micturition circuit (described above). The failure of the circuit is related to the frontal and pontine regulatory centers . Such a failure eventually causes various complications, such as decreased bladder and kidney function and urinary tract infection (UTI), which ultimately extends a patient's hospitalization …”

“…Prior studies focused on assessing the prevalence of POUR according to the type of surgery and anesthesia, identifying risk factors, and on the diagnosis, prevention, and treatment of POUR . A strong positive relationship between spinal surgery and POUR has been reported . In contrast, the prevalence of POUR in laparoscopic cholecystectomy, a standard operation these days, has been reported to range from as low as 0.1% to as high as 16.4%, 15–20 and the prevalence of POUR for cholecystectomy as a whole has been reported be as high as 30%, which means that it can be considered as common.…”