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Xu L, Tao ZY, Lu JY, Zhang GN, Qiu HZ, Wu B, Lin GL, Xu T, Xiao Y. A single-center, prospective, randomized clinical trial to investigate the optimal removal time of the urinary catheter after laparoscopic anterior resection of the rectum: study protocol for a randomized controlled trial. Trials 2019; 20:133. [PMID: 30770766 PMCID: PMC6377729 DOI: 10.1186/s13063-019-3210-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 01/18/2019] [Indexed: 01/28/2023] Open
Abstract
Background Urinary catheter placement is essential before laparoscopic anterior resection for rectal cancer. Whether early removal of the catheter increases the incidence of urinary retention and urinary tract infection (UTI) is not clear. This study aims to determine the optimal time for removal of the urinary catheter after laparoscopic anterior resection of the rectum. Methods/design A total of 220 participants meeting the inclusion criteria will be randomly assigned to an experimental group or a control group. The experimental group will have their urethral catheters removed on postoperative day 2 and the control group will have their urethral catheters removed on postoperative day 7. In both groups, catheter removal will be performed when the bladder is full. The incidence of urinary retention and UTI in the two groups will be compared to determine the optimal catheter removal time. Discussion This is a prospective, single-center, randomized controlled trial to determine whether early removal of the urinary catheter after laparoscopic anterior resection of the rectum will help to decrease the incidence of postoperative acute urinary retention and UTI. Trial registration ClinicalTrials.gov, NCT03065855. Registered on 23 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3210-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lai Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhi-Yan Tao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jun-Yang Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Guan-Nan Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Guo-Le Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, #5 Dongdan San Tiao, Beijing, 100005, People's Republic of China
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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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: 27] [Impact Index Per Article: 5.4] [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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High Risk of Postoperative Urinary Retention in 1-Year-Old Cleft Palate Patients: An Observational Study. J Perianesth Nurs 2017; 31:41-8. [PMID: 26847779 DOI: 10.1016/j.jopan.2014.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/27/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Estimate the frequency of urinary catheterizations in a high-risk population of children. DESIGN It was a descriptive, observational study. METHODS Incidence of postoperative urinary retention was recorded for one-year-old cleft palate surgery patients admitted to the postanaesthesia care unit or pediatric intensive care unit at Rikshospitalet, Oslo University Hospital, Norway. FINDING Forty-five out of 70 patients (64%) were catheterized once or several times during the perioperative period. Furthermore, a total of 40 out of 54 patients (74%) had a bladder volume 60 mL or more measured by ultrasound scanner; 10 of these measured volumes exceeded twice the bladder capacity. CONCLUSIONS Postoperative urinary retention was discovered in 64% of patients; some of them were catheterized more than once during the perioperative period. Based on these data and the departmental procedure for postoperative care of these patients, the results indicated the need for an indwelling catheter.
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The number of in-out catheterisations is reduced by mobilising the postoperative patient with bladder needs to the toilet in the recovery room. Eur J Anaesthesiol 2015; 32:486-92. [DOI: 10.1097/eja.0000000000000214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoon YE, Lee JW, Park SY, Park HY, Lee TY, Kim YT. Predictive Factors for Recovery from Acute Urinary Retention after Non-Urogenital Surgery. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.10.976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Young Eun Yoon
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jae Won Lee
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Sung Yul Park
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hae Young Park
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Tchun Yong Lee
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Tae Kim
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
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Management of temporary urinary retention after arthroscopic knee surgery in low-dose spinal anesthesia: development of a simple algorithm. Arch Orthop Trauma Surg 2008; 128:607-12. [PMID: 17968566 DOI: 10.1007/s00402-007-0481-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In practice, trauma and orthopedic surgery during spinal anesthesia are often performed with routine urethral catheterization of the bladder to prevent an overdistention of the bladder. However, use of a catheter has inherent risks. Ultrasound examination of the bladder (Bladderscan) can precisely determine the bladder volume. Thus, the aim of this study was to identify parameters indicative of urinary retention after low-dose spinal anesthesia and to develop a simple algorithm for patient care. MATERIALS AND METHODS This prospective pilot study approved by the Ethics Committee enrolled 45 patients after obtaining their written informed consent. Patients who underwent arthroscopic knee surgery received low-dose spinal anesthesia with 1.4 ml 0.5% bupivacaine at level L3/L4. Bladder volume was measured by urinary bladder scanning at baseline, at the end of surgery and up to 4 h later. The incidence of spontaneous urination versus catheterization was assessed and the relative risk for catheterization was calculated. Mann-Whitney test, chi(2) test with Fischer Exact test and the relative odds ratio were performed as appropriate. *P < 0.05. RESULTS Seventy percent of the patients were able to void spontaneously; in 30%, a Foley catheter had to be inserted because bladder volume exceeded 500 ml and/or urination was insufficient (P < 0.01). Bladder volume differed independently of the fluid infused. Additionally, patients with a bladder volume >300 ml postoperatively had a 6.5-fold greater likelihood for urinary retention. CONCLUSION In the management of patients with short-lasting spinal anesthesia for arthroscopic knee surgery we recommend monitoring bladder volume by Bladderscan instead of routine catheterization. Anesthesiologists or nurses under protocol should assess bladder volume preoperatively and at the end of surgery. If bladder volume is >300 ml, catheterization should be performed in the OR. Patients with a bladder volume of <300 ml at the end of surgery may be transferred to the ward or recovery room. In these patients, bladder volume must be checked at least every 60 min for a maximum of 3 h or until spontaneous voiding is possible or bladder volume is >500 ml.
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Musselwhite KL, Faris P, Moore K, Berci D, King KM. Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol 2007; 196:472.e1-5. [PMID: 17466708 DOI: 10.1016/j.ajog.2006.11.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 09/18/2006] [Accepted: 11/29/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between the use of epidural analgesia during labor and acute postpartum urinary retention. STUDY DESIGN A retrospective cohort study was conducted using 1994 labor and postpartum health records from 3 primary care centers. RESULTS Logistic regression analysis revealed that a longer second stage of labor (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.41-4.85), use of systemic narcotics (OR 1.63; 95% CI 1.04-2.57), perineal laceration (OR 1.73; 95% CI 1.02-2.91), and instrumental delivery (OR 1.86; 95% CI 1.16-2.97) predicted urinary retention. There was a trend toward association of epidural analgesia and urinary retention (OR 1.69; 95% CI 0.98-2.92). Propensity score analysis revealed that any effect of epidural analgesia was likely due to effect modification of other obstetric variables. CONCLUSION Epidural analgesia during labor may increase the risk of developing urinary retention by up to 3 times. However, this effect is mediated by other obstetric variables.
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Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, Tanaka Y, Suzuki K, Masuda J, Tanaka M. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 2006; 21:676-82. [PMID: 16552523 DOI: 10.1007/s00384-005-0077-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2005] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was undertaken to determine the incidence of and risk factors for urinary retention after surgery for benign anorectal disease. METHODS We reviewed 2,011 consecutive surgeries performed under spinal anesthesia for benign anorectal disease from January through June 2003 to identify potential risk factors for postoperative urinary retention. In addition, we prospectively investigated the preventive effect of perioperative fluid restriction and pain control by prophylactic analgesics on postoperative urinary retention. RESULTS The number of procedures and the urinary retention rates were as follows: hemorrhoidectomy, 1,243, 21.9%; fistulectomy, 349, 6.3%; incision/drainage, 177, 2.3%; and sliding skin graft/lateral subcutaneous internal sphincterotomy, 64, 17.2%. The overall urinary retention rate was 16.7%. With hemorrhoidectomy, female sex, presence of preoperative urinary symptoms, diabetes mellitus, need for postoperative analgesics, and more than three hemorrhoids resected were independent risk factors for urinary retention as assessed by multivariate analysis. With fistulectomy, female sex, diabetes mellitus, and intravenous fluids >1,000 ml were independent risk factors for urinary retention. Perioperative fluid restriction, including limiting the administration of intravenous fluids, significantly decreased the incidence of urinary retention (7.9 vs 16.7%, P<0.0001). Furthermore, prophylactic analgesic treatment significantly decreased the incidence of urinary retention (7.9 vs 25.6%, P=0.0005). CONCLUSIONS Urinary retention is a common complication after anorectal surgery. It is linked to several risk factors, including increased intravenous fluids and postoperative pain. Perioperative fluid restriction and adequate pain relief appear to be effective in preventing urinary retention in a significant number of patients after anorectal surgery.
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Affiliation(s)
- Takayuki Toyonaga
- Department of Surgery, Matsushima Hospital Colo-Proctology Center, 19-11 Tobehoncho, Nishi-ku, Yokohama, Japan.
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Rosseland LA, Bentsen G, Hopp E, Refsum S, Breivik H. Monitoring urinary bladder volume and detecting post-operative urinary retention in children with an ultrasound scanner. Acta Anaesthesiol Scand 2005; 49:1456-9. [PMID: 16223389 DOI: 10.1111/j.1399-6576.2005.00817.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-operative urinary retention (PUR) is associated with a risk of over-distension and permanent detrusor damage. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Post-operative monitoring of the bladder volume is a reliable method in adults, but has not been evaluated for reliability in children. METHODS Forty-eight patients who, according to current clinical guidelines, required urinary bladder emptying were scanned before catheterization using the Bladderscan. Volumes estimated with ultrasound were compared with volumes measured after emptying the bladder with a catheter. Bladder emptying was controlled by concomitant fluoroscopy in 20 children. RESULTS The mean difference between the ultrasound estimates and the catheter-emptied urine volumes was 4 ml [standard deviation (SD) = 25 ml] in 26 children above the age of 3 years and -18 ml (SD = 19 ml) in 22 younger children. In the subpopulation in whom complete bladder emptying could be confirmed by fluoroscopy (14 children; median age, 3 years; range, 1-11 years), the mean difference between the ultrasound estimates and the catheter-emptied volumes was -11 ml (SD = 24 ml). CONCLUSIONS This study confirms agreement between the ultrasound scanner estimates of urinary bladder volume and the urine volume measured by emptying the bladder. Reliability was good in children above the age of 3 years. The volume was underestimated in younger children. Thus, routine monitoring of urinary bladder volume with an ultrasound scanner is a non-invasive, pain-free and reliable way of preventing over-distension of the urinary bladder in children after surgery and other procedures under general anaesthesia.
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Affiliation(s)
- L A Rosseland
- Department of Anaesthesiology, Rikshospitalet University Hospital, N-0027 Oslo, Norway.
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Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with an ultrasound scanner. Acta Anaesthesiol Scand 2002; 46:279-82. [PMID: 11939918 DOI: 10.1034/j.1399-6576.2002.t01-1-460309.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Retention of urine is a common postoperative problem associated with risk of overdistention and permanent detrusor damage. Prevention of urinary retention by insertion of indwelling catheter may increase the risk of urinary infection. We have performed a reliability test of an ultrasound scanner, implemented in the postoperative monitoring equipment. METHODS Patients were monitored after different types of surgery under spinal anesthesia with an ultrasound scanner in the postanesthesia care unit (PACU). PATIENTS Patients who according to current guidelines required a urinary bladder catheter, were scanned before a catheter was inserted and urine volume was measured. These two urine volumes were compared and analyzed for agreement. RESULTS Nineteen female and 17 male patients were included. The mean difference between ultrasound estimates and catheter urine volume measurements was - 21.5 mL, and limits of agreement, calculated as a 95% confidence interval, were - 147 and + 104 mL. This means that the urine volume estimated by ultrasound was on average 21.5 mL smaller than the urine volume when the bladder was emptied. CONCLUSION This study confirms a good agreement between the ultrasound scanner estimates of urinary bladder volume and urine volume measured after emptying the bladder. Nurses in the PACU could operate the ultrasound scanner after a brief instruction and training period. Considering the potentially serious long-term consequences of undiagnosed postoperative urinary retention, introducing this equipment for routine monitoring of urinary bladder volume should be considered.
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Affiliation(s)
- L A Rosseland
- Department of Anesthesia, Lillehammer Hospital, Lillehammer, Norway.
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Walter JS, Tang PC, Wheeler JS. Effects of bladder volume on detrusor contractility during sacral nerve stimulation. Neurourol Urodyn 1991. [DOI: 10.1002/nau.1930100107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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