Prevalence and risk factors of urinary incontinence and bladder retention in gastric bypass surgery: a cross-sectional study

Mitigation of postoperative urinary retention among total joint replacement patients using the ERAS protocol and applying risk-stratified catheterization

BACKGROUNDS

We intended to identify the incidence and risk factors (RFs) for Postoperative urinary retention (POUR) after applying a risk-stratified catheterization optimization method in enhanced recovery after surgery (ERAS)-total joint arthroplasty (TJA).

METHODS

A total of 381 patients were prospectively monitored for POUR. POUR diagnosis was done by a perioperative specialist. Data on potential risk factors (RFs) for POUR were accumulated. Univariate analysis (UA) was conducted to identify possible indicators of POUR, followed by multivariate analysis (MA) of identified indicators.

RESULTS

POUR occurred in 5.5% of cases, including 8 (3.4%) patients underwent total knee arthroplasty and 13 (10.4%) patients underwent total hip arthroplasty. In UA, age, sex, American Society of Anesthesiologists (ASA) score, and the type of operation were significantly different on UA (P = 0.046, P = 0.022, P = 0.000 and P = 0.049, respectively). Other additional predictors, including body mass index (BMI), international prostate symptom score (IPSS) score, preoperative haemoglobin (Hb), duration of operation, estimated intraoperative blood loss, intraoperative fluid volume, fluid infusion volume within 24 h postoperatively were not associated with POUR (P > 0.05). MA results demonstrated that age, ASA score, type of operation and standard intraoperative placement of an indwelling bladder catheter (SIP-IBC) were strongly associated with POUR development risk (P < 0.05).

CONCLUSION

Overall, we had a low POUR incidence in our study cohort. However, with the shift from non-ERAS TJA to ERAS TJA protocol, it is crucial to closely monitor the male gender, advanced age, THA and SIP-IBC, as these variables can markedly enhance POUR risk.

Avoidance of urinary drainage during perioperative period of open elective colonic resection within enhanced recovery after surgery programme

Background

Urinary catheterization (UC) is a conventional perioperative measure for major abdominal operation. Optimization of perioperative catheter management is an essential component of the enhanced recovery after surgery (ERAS) programme. We aimed to investigate the risk factors of urinary retention (UR) after open colonic resection within the ERAS protocol and to assess the feasibility of avoiding urinary drainage during the perioperative period.

Methods

A total of 110 colonic-cancer patients undergoing open elective colonic resection between July 2014 and May 2018 were enrolled in this study. All patients were treated within our ERAS protocol during the perioperative period. Data on patients’ demographics, clinicopathologic characteristics, and perioperative outcomes were collected and analysed retrospectively.

Results

Sixty-eight patients (61.8%) underwent surgery without any perioperative UC. Thirty patients (27.3%) received indwelling UC during the surgical procedure. Twelve (10.9%) cases developed UR after surgery necessitating UC. Although patients with intraoperative UC had a lower incidence of post-operative UR [0% (0/30) vs 15% (12/80), P = 0.034], intraoperative UC was not testified as an independent protective factor in multivariate logistic analysis. The history of prostatic diseases and the body mass index were strongly associated with post-operative UR. Six patients were diagnosed with post-operative urinary-tract infection, among whom two had intraoperative UC and four were complicated with post-operative UR requiring UC.

Conclusion

Avoidance of urinary drainage for open elective colonic resection is feasible with the implementation of the ERAS programme as the required precondition. Obesity and a history of prostatic diseases are significant predictors of post-operative UR.

Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method

BACKGROUND

Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use.

OBJECTIVE

Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling urinary catheter placement and different timings of catheter removal for routine general and orthopaedic surgery procedures.

METHODS

Two multidisciplinary panels consisting of 13 and 11 members (physicians and nurses) for general and orthopaedic surgery, respectively, reviewed the available literature regarding the impact of different perioperative catheter use strategies. Using a standardised, multiround rating process, the panels independently rated clinical scenarios (91 general surgery, 36 orthopaedic surgery) for urinary catheter placement and postoperative duration of use as appropriate (ie, benefits outweigh risks), inappropriate or of uncertain appropriateness.

RESULTS

Appropriateness of catheter use varied by procedure, accounting for procedure-specific risks as well as expected procedure time and intravenous fluids. Procedural appropriateness ratings for catheters were summarised for clinical use into three groups: (1) can perform surgery without catheter; (2) use intraoperatively only, ideally remove before leaving the operating room; and (3) use intraoperatively and keep catheter until postoperative days 1-4. Specific recommendations were provided by procedure, with postoperative day 1 being appropriate for catheter removal for first voiding trial for many procedures.

CONCLUSION

We defined the appropriateness of indwelling urinary catheter use during and after common general and orthopaedic surgical procedures. These ratings may help reduce catheter-associated complications for patients undergoing these procedures.

Effect of Bariatric Surgery on Urinary Incontinence in Obese Women: A Meta-analysis and Systematic Review

OBJECTIVES

The aim of this study was to explore the effectiveness of bariatric surgery in obese women with urinary incontinence (UI) through meta-analysis.

METHODS

Searches of PubMed, the Cochrane Library, and EMBASE databases were performed using "weight loss surgery/bariatric surgery/gastric bypass surgery" and "incontinentia urinae/uracratia/urinary incontinence/uroclepsia" in the title/abstract before January 2018. Then, meta-analysis was analyzed by Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom). The standardized mean difference (SMD) and odds ratio (OR) were used to describe results of continuous variables and dichotomous variables, respectively.

RESULTS

Pooled data showed that bariatric surgery reduced the incidence of UI in obese women at the follow-up of 6 months (OR, 3.27; 95% confidence interval [CI], 2.55-4.21; P < 0.00001) and 12 months (OR, 4.04; 95% CI, 2.62-6.22; P < 0.00001) and significantly reduced the body mass index at 6 months (SMD, 1.86; 95% CI, 1.19-2.53; P < 0.00001) and 12 months (SMD, 2.04; 95% CI, 1.44-2.64; P < 0.00001). In addition, bariatric surgery could also significantly increase the quality of life (SMD, 0.53; 95% CI, 0.27-0.80; P < 0.00001) and improve the function of pelvic floor disorders (SMD, 0.55; 95% CI, 0.38-0.72; P < 0.00001) based on quality-of-life questionnaires and Pelvic Floor Distress Inventory 20, respectively.

CONCLUSIONS

This meta-analysis demonstrated that bariatric surgery is an effective choice for obese women with UI. However, more randomized controlled trials are required to confirm this result.