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Malnik SL, Porche K, Mehkri Y, Yue S, Maciel CB, Lucke-Wold BP, Robicsek SA, Decker M, Busl KM. Leveraging machine learning to develop a postoperative predictive model for postoperative urinary retention following lumbar spine surgery. Front Neurol 2024; 15:1386802. [PMID: 38988605 PMCID: PMC11233696 DOI: 10.3389/fneur.2024.1386802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Postoperative urinary retention (POUR) is the inability to urinate after a surgical procedure despite having a full bladder. It is a common complication following lumbar spine surgery which has been extensively linked to increased patient morbidity and hospital costs. This study hopes to development and validate a predictive model for POUR following lumbar spine surgery using patient demographics, surgical and anesthesia variables. Methods This is a retrospective observational cohort study of 903 patients who underwent lumbar spine surgery over the period of June 2017 to June 2019 in a tertiary academic medical center. Four hundred and nineteen variables were collected including patient demographics, ICD-10 codes, and intraoperative factors. Least absolute shrinkage and selection operation (LASSO) regression and logistic regression models were compared. A decision tree model was fitted to the optimal model to classify each patient's risk of developing POUR as high, intermediate, or low risk. Predictive performance of POUR was assessed by area under the receiver operating characteristic curve (AUC-ROC). Results 903 patients were included with average age 60 ± 15 years, body mass index of 30.5 ± 6.4 kg/m2, 476 (53%) male, 785 (87%) white, 446 (49%) involving fusions, with average 2.1 ± 2.0 levels. The incidence of POUR was 235 (26%) with 63 (7%) requiring indwelling catheter placement. A decision tree was constructed with an accuracy of 87.8%. Conclusion We present a highly accurate and easy to implement decision tree model which predicts POUR following lumbar spine surgery using preoperative and intraoperative variables.
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Affiliation(s)
- Samuel L. Malnik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Yusuf Mehkri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Sijia Yue
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Carolina B. Maciel
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Brandon P. Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Steven A. Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Matthew Decker
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Katharina M. Busl
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, United States
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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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Gao B, Zhang D, Wang Y, Wang Z, Wang Z. The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:441-451. [PMID: 36445384 DOI: 10.1007/s00210-022-02343-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Tamsulosin is a therapeutic drug of alpha-adrenergic antagonists. Previous randomized controlled trials and retrospective analyses have proved the efficacy of tamsulosin on many urinary system diseases. However, there is still a conflict about whether tamsulosin could prevent postoperative urinary retention (POUR). This meta-analysis aims to probe into the efficacy of tamsulosin for preventing POUR versus placebo. We searched MEDLINE, EMBASE, and Cochrane Library from December 31, 1999 to April 30, 2022, for randomized controlled trials (RCTs). Studies that were not RCTs or without negative controls were excluded. Cochrane Collaboration harmonized criteria were used to assess the risk of bias in included studies. Revman (version 5.3) software was invited to synthesize the results. We performed subgroup analyses to explore the factors that could influence tamsulosin's efficacy in POUR prevention. Our meta-analysis pooled 13 RCTs with 2163 patients. We concluded that tamsulosin brought about a significant reduction in the risk of POUR versus placebo (13.54% vs 20.88% for tamsulosin vs placebo, RR = 0.63, 95% CI 0.47 to 0.84, P = 0.002). Tamsulosin could significantly reduce the risk of POUR in abdominal (11.52% vs 20.25% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.88, P = 0.02) and female pelvic surgery (15.57% vs 31.50% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.82, P = 0.006) but not in spinal surgery (13.45% vs 12.75% for tamsulosin vs placebo, RR = 1.07, 95% CI 0.72 to 1.60, P = 0.73) and lower limb surgery (21.43% vs 33.33% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.35 to 1.14, P = 0.13). The preventive effect of postoperative (17.70% vs 33.93% for tamsulosin vs placebo, RR = 0.53, 95% CI 0.33 to 0.85, P = 0.008) and postoperative with preoperative tamsulosin (13.96% vs 23.44% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.43 to 0.93, P = 0.02) on POUR were significantly better than preoperative management (11.95% vs 14.63% for tamsulosin vs placebo, RR = 0.62, 95% CI 0.23 to 1.65, P = 0.34). Postoperative catheter placement appears to have a negative impact on the POUR-preventive effect of tamsulosin. (9.37% vs 16.46% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.83, P = 0.007) Tamsulosin showed significantly effect on POUR prevention in patients during spinal (15.07% vs 26.51% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.90, P = 0.02) and epidural anesthesia (12.50% vs 29.79% for tamsulosin vs placebo, RR = 0.42, 95% CI 0.18 to 1.00, P = 0.05) but not in general anesthesia (12.40% vs 18.52% for tamsulosin vs placebo, RR = 0.68, 95% CI 0.45 to 1.03, P = 0.07). Tamsulosin shows better outcomes for preventing POUR than placebo. Besides, tamsulosin showed a different effect on POUR prevention in the various surgical sites, anesthesia, medication management, and catheter use. However, our conclusions still have some limitations due to the lack of evidence.
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Affiliation(s)
- Bixi Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China.,Institute of Stroke Research, Soochow University, Suzhou, 215006, China
| | - Dingding Zhang
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China
| | - Yunjiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China.,Institute of Stroke Research, Soochow University, Suzhou, 215006, China.,Department of Neurosurgery, Yancheng Third People's Hospital, Jiangsu Province, Yancheng, 224000, China
| | - Zongqi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China. .,Institute of Stroke Research, Soochow University, Suzhou, 215006, China.
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China. .,Institute of Stroke Research, Soochow University, Suzhou, 215006, China.
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4
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Huang YT, Chang Y, Kang YN, Huang CH, Lin YS, Wu J, Chi KY, Chen WC. Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis. BJS Open 2023; 7:6972435. [PMID: 36611262 PMCID: PMC9825733 DOI: 10.1093/bjsopen/zrac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/01/2022] [Accepted: 10/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Postoperative urinary retention (POUR) is a common complication following orthopaedic surgery. Previous studies attempted to establish the preventative role of α1-antagonist in POUR in the general surgical population; however, there is still no consensus regarding its use in orthopaedic surgery due to limited evidence. METHODS Electronic databases of Cochrane Library, Embase, MEDLINE, and ClinicalTrials.gov were searched by two independent investigators from inception to 1 March 2022 to identify relevant randomized clinical trials. Two reviewers independently completed a critical appraisal of included trials by using the Cochrane Risk of Bias tool version 2.0 and extracted data from included articles. Risk of POUR was summarized as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Mean difference (MD) was used for meta-analysis of continuous outcomes. RESULTS Five randomized clinical trials involving 878 patients (α1-antagonist, 434; placebo, 444) undergoing hip/knee arthroplasty and spine surgeries were included. One study was assessed as high risk of bias from the randomization process and was excluded from the final meta-analysis. There was no difference in the risk of POUR between patients taking α1-antagonist and the placebo in arthroplasty (RR, 0.64; 95 per cent c.i., 0.36 to 1.14) and in spine surgeries (RR, 1.03; 95 per cent c.i., 0.69 to 1.55). There was no difference in length of stay (MD, -0.14 days; 95 per cent c.i., -0.33 to 0.05). Use of α1-antagonist was associated with a higher risk of adverse events (RR, 1.97; 95 per cent c.i., 1.27 to 3.06), with a composite of dizziness, light-headedness, fatigue, altered mental status, and syncope being the most commonly reported symptoms. CONCLUSION In patients undergoing spinal surgery and joint arthroplasty, routine administration of perioperative α1-antagonist does not decrease risk of POUR but does increase perioperative dizziness, light-headedness, and syncope.
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Affiliation(s)
| | | | - Yi-No Kang
- Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chin-Hsuan Huang
- Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Shiuan Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jeffrey Wu
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Chi
- Correspondence to: (Kuan-Yu Chi), Department of Internal Medicine, and Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan (e-mail: ); (Wei-Cheng) Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (e-mail: )
| | - Wei-Cheng Chen
- Correspondence to: (Kuan-Yu Chi), Department of Internal Medicine, and Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan (e-mail: ); (Wei-Cheng) Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (e-mail: )
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5
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Li H, Zhang W, Xu G, Wang D, Xu C, Zhang H, Zhang L, Li J, Tang P. Prophylactic tamsulosin can reduce the risk of urinary retention after surgery in male patients: A systematic review and meta-analysis. Front Surg 2022; 9:930707. [DOI: 10.3389/fsurg.2022.930707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveThe meta-analysis aimed to estimate the efficacy of prophylactic tamsulosin on postoperative urinary retention (POUR) in male patients.MethodsPapers were searched in the PubMed, Embase, Web of Science, and Cochrane Library databases with predetermined keywords up to March 1, 2022. The studies reporting the preventive efficacy of prophylactic tamsulosin on POUR among men were identified. Pooled risk ratios (RRs) were calculated based on the random-effects model. Meta-regression was performed to explore potential sources of heterogeneity.ResultsThere were 11 studies with 1,046 patients in the tamsulosin group and 1,113 patients in the control group. The risk of POUR was significantly lower in the tamsulosin group (123/1,046 [11.8%] vs. 238/1,119 [19.0%]; RR = 0.61; 95% confidence interval [CI] 0.43 to 0.87; P = 0.006; heterogeneity: I2 = 57%; P = 0.009). Administration of tamsulosin was related to higher risk of adverse events (57/688 [8.3%] vs. 33/624 [5.3%]; RR = 1.68; 95% CI: 1.13 to 2.48; P = 0.010; heterogeneity: I2 = 33%; P = 0.20). The level of evidence and mean age of the included patients were identified as the potential sources of heterogeneity.ConclusionThe present meta-analysis indicated that prophylactic tamsulosin helps in preventing POUR and younger patients might benefit more from this preventive regimen. Administrating tamsulosin was also associated with a possibly higher risk of adverse events.
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6
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Rughani A, Cushing D, Lary CW, Cox S, Jumper B, Johnson N, Florman J. Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial. J Neurosurg 2022; 137:1172-1179. [PMID: 35148516 DOI: 10.3171/2021.10.jns212393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to determine whether preoperative administration of tamsulosin decreases postoperative urinary retention after spine surgery. METHODS In this randomized, double-blind, placebo-controlled clinical trial performed at a single institution between 2016 and 2019, eligible males aged 50 to 85 years were administered tamsulosin or placebo for 5 days prior to elective spine surgery. Patients were excluded if they were taking alpha adrenergic blocking drugs; were allergic to tamsulosin, lactose, or sulfa drugs; had a preexisting indwelling urinary catheter, orthostatic hypotension, history of urological surgery, or renal failure; or were scheduled for cataract surgery within 2 weeks. Screening identified 1051 eligible patients (140 declined participation, 150 did not meet the inclusion criteria, and 151 did not enroll for other reasons). A total of 610 patients were randomly assigned to receive 0.4 mg oral tamsulosin or an identical placebo capsule for 5 days preoperatively and 2 days postoperatively. RESULTS A total of 497 patients were included in the final statistical analysis. The overall rate of postoperative urinary retention was 9.7%, and tamsulosin had no observed effect on reducing the rate of postoperative urinary retention as compared with placebo (9.4% vs 9.9%, p = 0.96). There were no significant differences in the reported adverse events between groups. Multivariate logistic regression was performed to model the effects of patient, surgical, and anesthetic factors on postoperative urinary retention, and the study drug remained an insignificant factor. CONCLUSIONS This study did not detect an effect of perioperative tamsulosin on reducing the rate of postoperative urinary retention in male patients aged 50 to 85 years who underwent elective spine surgery. This study does not support the routine use of tamsulosin to reduce postoperative urinary retention in patients without a previous prescription. It is unknown if subpopulations exist for which prophylactic tamsulosin may reduce postoperative urinary retention.
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Affiliation(s)
- Anand Rughani
- 1Neuroscience Institute, Maine Medical Center, Portland, Maine
- 2Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts
| | - Deborah Cushing
- 1Neuroscience Institute, Maine Medical Center, Portland, Maine
| | - Christine W Lary
- 3Center for Outcomes Research and Education, Maine Medical Center Research Institute, Portland, Maine
| | - Sara Cox
- 1Neuroscience Institute, Maine Medical Center, Portland, Maine
| | - Brian Jumper
- 4Department of Urology, Maine Medical Center, Portland, Maine; and
| | - Nathaniel Johnson
- 5Department of Urology, University of Vermont Medical Center, Burlington, Vermont
| | - Jeffrey Florman
- 1Neuroscience Institute, Maine Medical Center, Portland, Maine
- 2Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts
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Bhagat S, El-Kafsi J, Samraj K, Mastoridis S. Prophylactic administration of alpha-blockers for the prevention of post-operative urinary retention following inguinal hernia repair: A meta-analysis of randomized control trials. Surgeon 2022:S1479-666X(22)00112-3. [PMID: 36192296 DOI: 10.1016/j.surge.2022.09.002] [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: 07/22/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Inguinal hernia repair is a commonly performed surgical procedure performed in adult males. Urinary retention following surgery is a known complication likely due to the adrenergic over-stimulation of smooth muscles in the bladder neck and prostate. This effect could potentially be mitigated by the use of alpha-blocker medications. A meta-analysis of randomized control trials (RCTs) was performed to analyse the evidence behind the use of alpha-blockers in the prevention of post-operative urinary retention (POUR). METHODS A comprehensive search of PubMed, Embase, MedLine and Scopus was undertaken adhering to PRISMA guidelines. RCTs using alpha-blockers as a single point intervention were included. Data were analysed using a random-effects model. Risk of Bias (ROB) was assessed according to Cochrane guidelines. RESULTS Seven RCTs including 680 patients were included. The use of alpha-blockade reduced the incidence of urinary retention requiring catheterization (OR:0.23, 95% CI:0.07-0.70, p:0.009). No serious side-effects of alpha-blockers were reported. CONCLUSION Alpha-blockers are a safe and effective intervention to reduce the incidence of urinary retention following inguinal hernia repair surgery.
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Affiliation(s)
- Saumya Bhagat
- Department of Surgery, Wexham Park Hospital, Slough, SL2 4HL, United Kingdom
| | - Jihene El-Kafsi
- Department of Surgery, Wexham Park Hospital, Slough, SL2 4HL, United Kingdom
| | | | - Sotiris Mastoridis
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom.
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Ji L, Wang A, Fan Q, Zhang N, Weng L, Gu J. Prophylactic Moxibustion in Preventing Postoperative Urinary Retention of Hemorrhoidectomy: A Study Protocol for a Randomized Controlled Trial. Front Surg 2022; 9:898097. [PMID: 35865036 PMCID: PMC9294276 DOI: 10.3389/fsurg.2022.898097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Postoperative urinary retention (POUR) is one of the most common complications after hemorrhoidectomy. The best treatment for POUR is prevention and should be involved in the whole perioperative period. Moxibustion has been used to treat urinary retention for thousands of years, and clinical studies have also proved its effects. We try to carry out a randomized, controlled, prospective study to observe whether prophylactic moxibustion could effectively reduce the incidence of POUR of hemorrhoidectomy in 24 h. Methods This study is a single-center, evaluator-blinded, randomized, and controlled trial. Participants who meet the inclusion and exclusion criteria in this RCT will be randomly assigned to either the treatment group (moxibustion) or the control group (tamsulosin hydrochloride) in a 1:1 ratio according to a computer-generated randomization list. Both moxibustion and tamsulosin will be used 1, 10, and 24 h after operation, respectively. The outcomes of occurrence of POUR, time to first urination, catheterization rate, urinary tract infection, length of hospitalization, and adverse effects will be recorded. Discussion The findings of the study will help to explore the preventive efficacy of prophylactic moxibustion against POUR of hemorrhoidectomy in 24 h. Trial Registration CHiCTR, CHiCTR2000039350, registered 24 October, 2020, http://www.chictr.org.cn/showproj.aspx?proj = 63204.
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Affiliation(s)
- Lijiang Ji
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Aihua Wang
- Rheumatology and Immunology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qian Fan
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Naijin Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Liping Weng
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jing Gu
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
- Correspondence: Jing Gu
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9
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Barra MF, Kaplan NB, Balkissoon R, Drinkwater CJ, Ginnetti JG, Ricciardi BF. Same-Day Outpatient Lower-Extremity Joint Replacement: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202206000-00003. [PMID: 35727992 DOI: 10.2106/jbjs.rvw.22.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ The economics of transitioning total joint arthroplasty (TJA) to standalone ambulatory surgery centers (ASCs) should not be capitalized on at the expense of patient safety in the absence of established superior patient outcomes. ➢ Proper patient selection is essential to maximizing safety and avoiding complications resulting in readmission. ➢ Ambulatory TJA programs should focus on reducing complications frequently associated with delays in discharge. ➢ The transition from hospital-based TJA to ASC-based TJA has substantial financial implications for the hospital, payer, patient, and surgeon.
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Affiliation(s)
- Matthew F Barra
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Nathan B Kaplan
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Rishi Balkissoon
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Christopher J Drinkwater
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - John G Ginnetti
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.,Center for Musculoskeletal Research, Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, New York
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10
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Porche K, Maciel CB, Lucke-Wold B, Robicsek SA, Chalouhi N, Brennan M, Busl KM. Preoperative prediction of postoperative urinary retention in lumbar surgery: a comparison of regression to multilayer neural network. J Neurosurg Spine 2022; 36:32-41. [PMID: 34507288 PMCID: PMC9608355 DOI: 10.3171/2021.3.spine21189] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spine surgery and is associated with prolongation of hospital stay, increased hospital cost, increased rate of urinary tract infection, bladder overdistention, and autonomic dysregulation. POUR incidence following spine surgery ranges between 5.6% and 38%; no reliable prediction tool to identify those at higher risk is available, and that constitutes an important gap in the literature. The objective of this study was to develop and validate a preoperative risk model to predict the occurrence of POUR following routine elective spine surgery. METHODS The authors conducted a retrospective chart review of consecutive adults who underwent lumbar spine surgery between June 1, 2017, and June 1, 2019. Patient characteristics, preexisting ICD-10 codes, preoperative pain and opioid use, preoperative alpha-1 blocker use, details of surgical planning, development of POUR, and management strategies were abstracted from electronic medical records. A binomial logistic model and a multilayer perceptron (MLP) were optimized using training and validation sets. The models' performance was then evaluated on model-naïve patients (not a part of either cohort). The models were then stacked to take advantage of each model's strengths and to avoid their weaknesses. Four additional models were developed from previously published models adjusted to include only relevant factors (i.e., factors known preoperatively and applied to the lumbar spine). RESULTS Overall, 891 patients were included in the cohort, with a mean of 59.6 ± 15.5 years of age, 52.7% male, BMI 30.4 ± 6.4, American Society of Anesthesiologists class 2.8 ± 0.6, and a mean of 5.6 ± 5.7 comorbidities. The rate of POUR was found to be 25.9%. The two models were comparable, with an area under the curve (AUC) of 0.737 for the regression model and 0.735 for the neural network. By combining the two models, an AUC of 0.753 was achieved. With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, maximal sensitivity and specificity were achieved, with specificity 68.2%, sensitivity 72.9%, negative predictive value 88.2%, and positive predictive value 43.4%. Both models individually outperformed previously published models (AUC 0.516-0.645) when applied to the current data set. CONCLUSIONS This predictive model can be a powerful preoperative tool in predicting patients who will be likely to develop POUR. By using a combination of regression and neural network modeling, good sensitivity, specificity, and NPV are achieved.
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Affiliation(s)
- Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carolina B. Maciel
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Steven A. Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Nohra Chalouhi
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Meghan Brennan
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Katharina M. Busl
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
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Bieri U, Slieker J, Hefermehl LJ, Soppe S, Teufelberger G, Tedaldi R, Graf N, Bieri M, Nocito A. Randomised, quadruple blinded, placebo controlled, multicentre trial investigating prophylactic tamsulosin in prevention of postoperative urinary retention in men after endoscopic total extraperitoneal inguinal hernia repair (STOP-POUR trial): a study protocol. BMJ Open 2021; 11:e048911. [PMID: 34876420 PMCID: PMC8655554 DOI: 10.1136/bmjopen-2021-048911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Postoperative urinary retention (POUR) is a common complication after inguinal hernia repair with a reported incidence up to 34%. It can be described as the inability to initiate urination or insufficient bladder emptying following surgery. It usually requires the use of catheterisation to empty the bladder in order to prevent further injury to the bladder or kidneys and to relief from pain. Tamsulosin is a medication that is commonly used in men with urinary symptoms related to an enlarged prostate. There is some evidence to suggest that it may also potentially be beneficial for preventing POUR. METHODS AND ANALYSIS This is a multicentre, blinded, prospective, phase IV randomised controlled trial with parallel allocation. Six hundred and thirty-four patients scheduled for elective endoscopic inguinal hernia repair surgery will be recruited. There will be effective (concealed) randomisation of the subjects to the intervention/control groups. Group assignment will be performed using a covariate-adaptive allocation procedure to provide a balance for selected covariates. The interventional group receives 0.4 mg tamsulosin hydrochloride and the control-group receives one placebo capsule matching the active study drug, both daily, starting from 5 days prior to the day of surgery, at the day of surgery and for 1 day following surgery. The primary outcome is any need for urinary catheterisation postoperatively as a binary outcome. Secondary outcome measures include postoperative pain, change in International Prostate Symptom Score from baseline prior to surgery to after surgery and hospital stay. ETHICS AND DISSEMINATION The study has been approved by the Northwestern and Central Switzerland Ethics Committee (2020-00569) and it is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Study results will be disseminated through peer-reviewed journals and national and international scientific conferences. TRIAL REGISTRATION NUMBERS SNCTP000003904. NCT04491526.
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Affiliation(s)
- Uwe Bieri
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Juliette Slieker
- Department for General, Visceral and Vascular Surgery, Kantonsspital Baden, Baden, Switzerland
| | - Lukas John Hefermehl
- Department of Surgery, Division of Urology, Kantonsspital Baden, Baden, Switzerland
| | - Sebastian Soppe
- Department for General, Visceral and Vascular Surgery, Kantonsspital Baden, Baden, Switzerland
| | | | - Regula Tedaldi
- Department of General Surgery, Spital Muri, Muri, Switzerland
| | | | - Marco Bieri
- Commissioning and Qualification Engineer, Rotkreuz, Switzerland
| | - Antonio Nocito
- Department for General, Visceral and Vascular Surgery, Kantonsspital Baden, Baden, Switzerland
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12
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Reddy S, K K, P.N S, R D. Study on the Efficacy of Tamsulosin in Prevention of Post-operative Urinary Retention in Patients Undergoing Hemorrhoidectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Mattevi C, van Coppenolle C, Selvy M, Pereira B, Slim K. Systematic review and meta-analysis of early removal of urinary catheter after colorectal surgery with infraperitoneal anastomosis. Langenbecks Arch Surg 2021; 407:15-23. [PMID: 34599682 DOI: 10.1007/s00423-021-02342-2] [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: 03/10/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection. METHODS We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model. RESULTS Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8). CONCLUSION This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.
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Affiliation(s)
- Catherine Mattevi
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | | | - Marie Selvy
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Hospital CHU, Clermont-Ferrand, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France. .,Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France. .,, Clermont-Ferrand, France.
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14
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Chapman GC, Sheyn D, Slopnick EA, Roberts K, El-Nashar SA, Henderson JW, Mangel J, Hijaz AK, Pollard RR, Mahajan ST. Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial. Am J Obstet Gynecol 2021; 225:274.e1-274.e11. [PMID: 33894146 DOI: 10.1016/j.ajog.2021.04.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative urinary retention is common after female pelvic reconstructive surgery. Alpha receptor antagonists can improve dysfunctional voiding by relaxing the bladder outlet and may be effective in reducing the risk of postoperative urinary retention. OBJECTIVE This study aimed to determine whether tamsulosin is effective in preventing postoperative urinary retention in women undergoing surgery for pelvic organ prolapse. STUDY DESIGN This was a multicenter, double-blind, randomized controlled trial between August 2018 and June 2020, including women undergoing surgery for pelvic organ prolapse. Patients were excluded from recruitment if they had elevated preoperative postvoid residual volume, history of postoperative urinary retention, or a contraindication to tamsulosin. Those who experienced cystotomy were excluded from analysis. Participants were randomized to a 10-day perioperative course of tamsulosin 0.4 mg vs placebo, beginning 3 days before surgery. A standardized voiding trial was performed on postoperative day 1. The primary outcome was the development of postoperative urinary retention, as defined by the failure of the voiding trial or subsequent need for catheterization to empty the bladder. Secondary outcomes included the rate of urinary tract infection and the impact on lower urinary tract symptoms as measured by the American Urological Association Symptom Index. RESULTS Of 119 patients, 57 received tamsulosin and 62 received placebo. Groups were similar in regard to demographics, preoperative prolapse and voiding characteristics, and surgical details. Tamsulosin was associated with a lower rate of postoperative urinary retention than placebo (5 patients [8.8%] vs 16 patients [25.8%]; odds ratio, 0.28; 95% confidence interval, 0.09-81; P=.02). The number needed to treat to prevent 1 case of postoperative urinary retention was 5.9 patients. The rate of urinary tract infection did not differ between groups. American Urological Association Symptom Index scores significantly improved after surgery in both groups (median total score, 14 vs 7; P<.01). Scores related to urinary stream improved more in the tamsulosin group than in placebo (P=.03). CONCLUSION In this placebo-controlled trial, tamsulosin use was associated with a reduced risk of postoperative urinary retention in women undergoing surgery for pelvic organ prolapse.
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Di Natale S, Slieker J, Soppe S, Bieri U, Keerl A, Nocito A. Risk Factors for Postoperative Urinary Retention After Endoscopic Hernia Repair: Age and Unilateral Operation make the Difference. World J Surg 2021; 45:3616-3622. [PMID: 34424402 DOI: 10.1007/s00268-021-06292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Postoperative urinary retention (POUR) is a common complication after inguinal hernia repair that may result in catheter-related infections or injuries, longer hospital stays, and thus, higher overall costs. Our aim was to assess the incidence of POUR after endoscopic total extraperitoneal (TEP) inguinal hernia repair and identify its risk factors. METHODS We retrospectively analyzed all data that were included in a prospective Hernia Database for patients undergoing a TEP inguinal hernia repair at our institution between July 2012 and May 2018. POUR was defined as the inability to urinate spontaneously after surgery, thus requiring a bladder catheter. RESULTS Data from 1570 patients were included. Sixty-five patients developed POUR, which was an incidence of 4.1%. In the univariate analysis, patients over 50 years of age (1.6% vs. 5.5%), patients with higher American Society of Anesthesiologists (ASA) score (ASA-1 2.7% vs. ASA-3 12.5%), previous prostate surgery (3.9% vs. 10.9%), unilateral operation (1.9% vs. 6.0%), and intraoperative drain placement (2.1% vs. 4.9%) developed POUR more often than younger patients. After multivariate adjustment, advanced age and unilateral surgery remained risk factors for POUR. CONCLUSION Advanced age and unilateral inguinal hernia repair, possibly due to a lack of catheterization, were risk factors for POUR. Due to increasing outpatient inguinal hernia repairs worldwide, it is imperative to identify patients who are at risk of POUR to apply prophylactic measures and reduce readmission, and thus, reduce health-care costs.
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Affiliation(s)
- S Di Natale
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - J Slieker
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - S Soppe
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - U Bieri
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - A Keerl
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - A Nocito
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland.
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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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Ellahi A, Stewart F, Kidd EA, Griffiths R, Fernandez R, Omar MI. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2021; 6:CD004011. [PMID: 34184246 PMCID: PMC8240009 DOI: 10.1002/14651858.cd004011.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling urethral catheterisation at some point during their care. However, the use of urinary catheters is associated with an increased risk of developing urinary tract infection. Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. It is estimated that around 20% of hospital-acquired bacteraemias arise from the urinary tract and are associated with mortality of around 10%. This is an update of a Cochrane Review first published in 2005 and last published in 2007. OBJECTIVES To assess the effects of strategies for removing short-term (14 days or less) indwelling catheters in adults. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 17 March 2020), and reference lists of relevant articles. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effectiveness of practices undertaken for the removal of short-term indwelling urethral catheters in adults for any reason in any setting. DATA COLLECTION AND ANALYSIS Two review authors performed abstract and full-text screening of all relevant articles. At least two review authors independently performed risk of bias assessment, data abstraction and GRADE assessment. MAIN RESULTS We included 99 trials involving 12,241 participants. We judged the majority of trials to be at low or unclear risk of selection and detection bias, with a high risk of performance bias. We also deemed most trials to be at low risk of attrition and reporting bias. None of the trials reported on quality of life. The majority of participants across the trials had undergone some form of surgical procedure. Thirteen trials involving 1506 participants compared the removal of short-term indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants; low-certainty evidence). We are uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low-certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants; low-certainty evidence). Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants; low-certainty evidence), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants; moderate-certainty evidence) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants; low-certainty evidence). Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants; low-certainty evidence). We are uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants; very low-certainty evidence) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants; very low-certainty evidence). Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. We are uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants; very low-certainty evidence) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants; very low-certainty evidence). None of the included trials investigating prophylactic alpha blockers reported the number of participants with dysuria. AUTHORS' CONCLUSIONS There is some evidence to suggest the removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. It appears that catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. The other evidence relating to the risk of symptomatic CAUTI and dysuria is too uncertain to allow us to draw any conclusions. Due to the low certainty of the majority of the evidence presented here, the results of further research are likely to change our findings and to have a further impact on clinical practice. This systematic review has highlighted the need for a standardised set of core outcomes, which should be measured and reported by all future trials comparing strategies for the removal of short-term urinary catheters. Future trials should also study the effects of short-term indwelling urethral catheter removal on non-surgical patients.
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Affiliation(s)
| | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emily A Kidd
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rhonda Griffiths
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Sirisreetreerux P, Wattanayingcharoenchai R, Rattanasiri S, Pattanaprateep O, Numthavaj P, Thakkinstian A. Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk-benefit analysis. Ther Adv Urol 2021; 13:17562872211022296. [PMID: 34211585 PMCID: PMC8216417 DOI: 10.1177/17562872211022296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Aims To assess the efficacy in lowering post-operative urinary retention, urinary tract infection and lower urinary tract symptoms and the incidence of adverse events among 12 interventions and to perform risk-benefit analysis. Methods Previous randomized controlled trials were identified from MEDLINE, Scopus and CENTRAL database up to January 2020. The interventions of interest included early ambulation, fluid adjustment, neuromodulation, acupuncture, cholinergic drugs, benzodiazepine, antispasmodic agents, opioid antagonist agents, alpha-adrenergic antagonists, non-steroidal anti-inflammatory drugs (NSAIDs) and combination of any interventions. The comparators were placebo or standard care or any of these interventions. Network meta-analysis was performed. The probability of being the best intervention was estimated and ranked using rankogram and surface under the cumulative ranking curve. Risk-benefit analysis was done. Incremental risk-benefit ratio (IRBR) was calculated and risk-benefit acceptability curve was constructed. Results A total of 45 randomized controlled trials with 5387 patients was included in the study. Network meta-analysis showed that early ambulation, acupuncture, alpha-blockers and NSAIDs significantly reduced the post-operative urinary retention. Regarding urinary tract infection and lower urinary tract symptoms, no statistical significance was found among interventions. Regarding the side effects, only alpha-adrenergic antagonists significantly increased the adverse events compared with acupuncture and opioid antagonist agents from the indirect comparison. According to the cluster ranking plot, acupuncture and early ambulation were considered high efficacy with low adverse events, corresponding to the IRBR. Conclusion Early ambulation, acupuncture, opioid antagonist agents, alpha-adrenergic antagonists and NSAIDs significantly reduce the incidence of post-operative urinary retention with no difference in adverse events. Regarding the risk-benefit analysis of the medical treatment, alpha-adrenergic antagonists have the highest probability of net benefit at the acceptable threshold of side effect of 15%, followed by opioid antagonist agents, NSAIDs and cholinergic drugs.
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Affiliation(s)
- Pokket Sirisreetreerux
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rujira Wattanayingcharoenchai
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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19
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Papageorge CM, Howington B, Leverson G, Kennedy GD, Carchman EH. Preoperative Tamsulosin to Prevent Postoperative Urinary Retention: A Randomized Controlled Trial. J Surg Res 2021; 262:130-139. [PMID: 33561724 DOI: 10.1016/j.jss.2020.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of tamsulosin, administered preoperatively, for the prevention of postoperative urinary retention (POUR). POUR is a common complication of abdominal surgery, leading to the use of urinary catheters, which are a risk factor for urinary tract infection. Tamsulosin is a uroselective alpha-1a blocker used for the treatment of lower urinary tract symptoms. MATERIALS AND METHODS A randomized, double-blind, placebo-controlled trial was undertaken from August 2015 to May 2018. Adults undergoing elective inpatient abdominal surgery were randomized to receive either tamsulosin 0.4 mg or placebo daily for 7 d before surgery and continuing for up to 7 d postoperatively. The primary outcome was need for at least a single intermittent catheterization postoperatively. Secondary outcomes included first postvoid residual volume, number of catheterizations, need for replacement of an indwelling catheter, hospital length of stay, and urinary tract infection within 30 d of surgery. RESULTS A total of 158 participants were enrolled, with a final analytic cohort of 141 participants. The two groups had similar baseline characteristics, operative characteristics, and timing of catheter removal. There was no difference in the incidence of POUR between the two groups (26% in tamsulosin versus 31% in placebo, P = 0.49). There was also no difference in any of the secondary outcomes between the two groups. Epidural usage, open surgery, and age <50 were identified as risk factors for POUR. CONCLUSIONS Perioperative prophylaxis with tamsulosin is not effective in reducing the incidence of POUR in patients undergoing elective abdominal surgery.
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Affiliation(s)
- Christina M Papageorge
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bailey Howington
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Glen Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory D Kennedy
- Department of Surgery, University of Alabama-Birmingham, Gardendale, Alabama
| | - Evie H Carchman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Caparelli ML, Shikhman A, Runyan B, Allamaneni S, Hobler S. The use of tamsulosin to prevent postoperative urinary retention in laparoscopic inguinal hernia repair: a randomized double-blind placebo-controlled study. Surg Endosc 2020; 35:5538-5545. [PMID: 33025252 DOI: 10.1007/s00464-020-08050-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The rate of postoperative urinary retention (POUR) in laparoscopic inguinal hernia repairs is 1-22%. POUR may cause patient anxiety, discomfort, and increased hospital costs. Currently there is no standard prophylaxis for POUR. Preoperative administration of tamsulosin has been shown to decrease POUR rates in urologic studies. This study aims to evaluate the efficacy of tamsulosin on the incidence of POUR in patients undergoing totally extraperitoneal (TEP) LIHR. METHODS A randomized, double-blinded, placebo-controlled trial was initiated and accrued patients from 2017 to 2019. A total of 169 males undergoing elective TEP LIHR were included. Patients were administered tamsulosin 2 h before surgery and followed for up to 24 h postoperatively for episodes of POUR. Analysis was performed to quantify the association between patient, surgical, and perioperative factors with POUR. RESULTS The overall rate of POUR was 9%. There was no difference in the rate of POUR between the placebo (9.9%) and tamsulosin groups (7.9%) (p = 0.433). Univariate analysis showed a trend toward POUR in patients with history of benign prostatic hypertrophy (BPH) (p = 0.058). Previously reported risk factors of older age, total IVF, length of procedure and opioid use were not associated with increased rates of POUR. Tamsulosin reduced the time to discharge by 4 to 68 min when compared to placebo. CONCLUSIONS This study suggests that preoperative administration of tamsulosin may not reduce the risk of POUR in males undergoing elective TEP LIHR. Further study with a larger sample size may be needed to show a statistically significant difference.
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Affiliation(s)
- Michael L Caparelli
- Department of Surgery, Jewish Hospital of Cincinnati, 4777 E Galbraith Rd, Cincinnati, OH, 45236, USA.
| | - Alexander Shikhman
- Department of Surgery, Jewish Hospital of Cincinnati, 4777 E Galbraith Rd, Cincinnati, OH, 45236, USA
| | - Brianne Runyan
- Department of Surgery, Jewish Hospital of Cincinnati, 4777 E Galbraith Rd, Cincinnati, OH, 45236, USA
| | - Shyam Allamaneni
- Department of Surgery, Jewish Hospital of Cincinnati, 4777 E Galbraith Rd, Cincinnati, OH, 45236, USA
| | - Scott Hobler
- Department of Surgery, Jewish Hospital of Cincinnati, 4777 E Galbraith Rd, Cincinnati, OH, 45236, USA
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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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22
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Post-operative urinary retention after lower extremity arthroplasty and the peri-operative role of selective alpha-1 adrenergic blocking agents in adult male patients: a propensity-matched retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2019; 44:39-44. [DOI: 10.1007/s00264-019-04420-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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23
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The AAHKS Clinical Research Award: Prophylactic Tamsulosin Does Not Reduce the Risk of Urinary Retention Following Lower Extremity Arthroplasty: A Double-Blinded Randomized Controlled Trial. J Arthroplasty 2019; 34:S17-S23. [PMID: 30982761 DOI: 10.1016/j.arth.2019.03.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postoperative urinary retention (POUR) is common. Selective alpha-1 adrenergic antagonists, such as tamsulosin, are effective for treating urinary retention. The purpose of this study is to determine whether perioperative prophylactic tamsulosin reduces the incidence of POUR following total hip and knee arthroplasty. METHODS Male patients 35 years of age and older undergoing primary total hip or knee arthroplasty at a single center from 2015 to 2018 were eligible for inclusion. Patients were randomized to receive tamsulosin 0.4 mg or placebo daily for 5 days preoperatively, the morning of surgery, and the first postoperative day. The incidence of POUR was determined during the postoperative hospitalization. RESULTS A total of 176 patients were enrolled in the study. Two patients were withdrawn prior to randomization. The remaining 174 were randomized to tamsulosin (n = 87) or placebo (n = 87). After an additional 43 patients were withdrawn prior to surgery, 131 patients completed the study (tamsulosin, n = 64; placebo, n = 67). A total of 42 patients (32.1%) developed POUR, with 18 cases (28.1%) in the tamsulosin group and 24 cases (35.8%) in the placebo group (P = .345), resulting in an odds ratio of 0.701 and a risk difference of 7.69%. CONCLUSION Prophylactic tamsulosin did not reduce the incidence of POUR after hip and knee arthroplasty compared to placebo. The odds ratio indicates an approximately 30% decreased odds of developing POUR in the tamsulosin group, albeit not statistically significant. Tamsulosin does not appear to be effective as a prophylactic measure for reducing POUR in male hip and knee arthroplasty patients.
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24
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Tamsulosin in urology: beyond benign prostatic hyperplasia. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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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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26
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Jackson J, Davies P, Leggett N, Nugawela MD, Scott LJ, Leach V, Richards A, Blacker A, Abrams P, Sharma J, Donovan J, Whiting P. Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS Open 2018; 3:11-23. [PMID: 30734011 PMCID: PMC6354194 DOI: 10.1002/bjs5.50114] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022] Open
Abstract
Background Postoperative urinary retention (PO‐UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO‐UR that might be alternatives to urinary catheterization. Methods Electronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO‐UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random‐effects meta‐analysis. The overall quality of the body of evidence was rated using the GRADE approach. Results Some 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO‐UR. Based on GRADE, there was high‐certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha‐blockers (number needed to treat to prevent one case of PO‐UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay. Conclusion Promising interventions exist for PO‐UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.
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Affiliation(s)
- J Jackson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - P Davies
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - N Leggett
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - M D Nugawela
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - L J Scott
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - V Leach
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - A Richards
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - A Blacker
- University Hospitals Coventry and Warwickshire Coventry UK
| | - P Abrams
- Bristol Urological Institute, North Bristol NHS Trust Bristol UK
| | - J Sharma
- University Hospitals Coventry and Warwickshire Coventry UK
| | - J Donovan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - P Whiting
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
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Tamsulosin to Prevent Postoperative Urinary Retention After Female Pelvic Reconstructive Surgery. Female Pelvic Med Reconstr Surg 2018; 26:682-687. [DOI: 10.1097/spv.0000000000000650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Early Urinary Catheter Removal Following Pelvic Colorectal Surgery: A Prospective, Randomized, Noninferiority Trial. Dis Colon Rectum 2018; 61:1180-1186. [PMID: 30192326 DOI: 10.1097/dcr.0000000000001206] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Because of the potential increased incidence of acute urinary retention, optimal timing of urinary catheter removal after major pelvic colorectal surgery remains unclear. OBJECTIVE This study aims to compare the incidence of urinary retention following early catheter removal on postoperative day 1 vs standard catheter removal on day 3. DESIGN This is a randomized, noninferiority trial. SETTING This study was conducted at an urban teaching hospital. PATIENTS Patients undergoing colorectal surgery below the peritoneal reflection were selected. INTERVENTIONS A 1:1 randomization to early or standard catheter removal was performed. Patients in the early arm were administered an α-antagonist (prazosin 1 mg oral) 6 hours before catheter removal. MAIN OUTCOME MEASURES The primary outcome measured was the incidence of acute urinary retention. RESULTS One hundred forty-two patients were randomly assigned to early (n = 71) or standard (n = 71) catheter removal. Mean age was 44.8 ± 16.9 years, and the study cohort included 54% men. The most common operations were IPAA (66%) and low anterior resection (18%). The overall rate of retention was 9.2% (n = 13), with no difference between early (n = 6; 8.5%) or standard (n = 7; 9.9%) catheter removal (RR, 0.86; 95% CI, 0.30-2.42). The risk difference was -1.4% (95% CI, -8.3 to 11.1), confirming noninferiority. The rate of infection was significantly lower in early vs standard catheter removal (0% vs 11.3%; p = 0.01). Length of stay was significantly shorter after early vs standard catheter removal (4 days, interquartile range = 3-6 vs 5 days, interquartile range = 4-7; p = 0.03). LIMITATIONS Patients and investigators were not blinded; a nonselective oral α-antagonist was used. CONCLUSIONS Following pelvic colorectal surgery, early urinary catheter removal, when combined with the addition of an oral α-antagonist, is noninferior to standard urinary catheter removal and carries a lower risk of symptomatic infection and shorter hospital stay. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov (NCT01923129). See Video Abstract at http://links.lww.com/DCR/A738.
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Ghuman A, de Jonge S, Dryden SD, Feeney T, Buitrago DH, Phang PT. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. Am J Surg 2018; 215:973-979. [DOI: 10.1016/j.amjsurg.2018.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
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30
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Ghuman A, Kasteel N, Karimuddin AA, Brown CJ, Raval MJ, Phang PT. Urinary retention in early urinary catheter removal after colorectal surgery. Am J Surg 2018; 215:949-952. [DOI: 10.1016/j.amjsurg.2018.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
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31
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Risk and Management of Postoperative Urinary Retention Following Spinal Surgery. Int Neurourol J 2017; 21:320-328. [PMID: 29298471 PMCID: PMC5756820 DOI: 10.5213/inj.1734994.497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose Postoperative urinary retention (POUR) is a common complication after spinal surgery. However, no clear definition of POUR currently exists, and no studies have evaluated the management of POUR. We aimed to investigate the prognostic factors for eventual POUR-free status in spinal surgery patients. Methods The records of patients who received a urologic consultation for POUR from January 2015 to December 2016 were reviewed. POUR-free status was defined as a voiding volume (VV) >100 mL and a VV ratio >50%. Patients with an indwelling Foley catheter and those with any postoperative complications were excluded. The patients were divided into 2 groups according to the primary management method (Foley catheterization [FC] or intermittent catheterization [IC]). Results In total, 205 patients (median age, 70.6 years) were evaluated. Significant prognostic factors for eventual POUR-free status were intraoperative FC, previous spinal surgery, operative level (L3–5), lumbar fusion, and total volume (TV) at the time of POUR. Bladder training and medication did not reduce the time to POUR-free status. In patients who underwent FC, the duration of indwelling FC was a significant prognostic factor for POUR-free status. In a subanalysis, the TV (≥500 mL) and VV ratio at the time of POUR were significant prognostic factors for POUR-free status after primary management. Among the patients who achieved a POUR-free status, 8 (6.4%) experienced recurrent POUR. The VV ratio (<62.0%) was the only predictor of recurrent POUR. Conclusions The criterion of POUR-free status is useful after spinal surgery. IC and FC were similar in their efficacy for the management of these patients.
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Akkoc A, Aydin C, Topaktas R, Kartalmis M, Altin S, Isen K, Metin A. Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia. Int Braz J Urol 2017; 42:578-84. [PMID: 27286124 PMCID: PMC4920578 DOI: 10.1590/s1677-5538.ibju.2015.0256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. MATERIALS AND METHODS A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. RESULTS There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). CONCLUSION This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.
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Affiliation(s)
- Ali Akkoc
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cemil Aydin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ramazan Topaktas
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mahir Kartalmis
- Department of Urology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Selcuk Altin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Kenan Isen
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ahmet Metin
- Department of Urology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
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Basheer A, Alsaidi M, Schultz L, Chedid M, Abdulhak M, Seyfried D. Preventive effect of tamsulosin on postoperative urinary retention in neurosurgical patients. Surg Neurol Int 2017; 8:75. [PMID: 28584678 PMCID: PMC5445651 DOI: 10.4103/sni.sni_5_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/02/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postoperative urinary retention (POUR) is common in neurosurgical patients. The use of alpha-blockade therapy, such as tamsulosin, has benefited many patients with a history of obstructive uropathy by decreasing lower urinary tract symptoms such as distension, infections, and stricture formation, as well as the incidence of POUR. For this study, we targeted patients who had undergone spinal surgery to examine the prophylactic effects of tamsulosin. Increased understanding of this therapy will assist in minimizing the morbidity of spinal surgery. METHODS We enrolled 95 male patients undergoing spine surgery in a double-blind, randomized, placebo-controlled trial. Patients were randomly assigned to receive either preoperative tamsulosin (N = 49) or a placebo (N = 46) and then followed-up prospectively for the development of POUR after removal of an indwelling urinary catheter (IUC). They were also followed-up for the incidence of IUC reinsertions. RESULTS The rate of developing POUR was similar in both the groups. Of the 49 patients given tamsulosin, 16 (36%) developed POUR compared to 13 (28%) from the control group (P = 0.455). In the control group, 5 (11%) patients had IUC re-inserted postoperatively, whereas 7 (14%) patients in the tamsulosin group had IUC re-inserted postoperatively (P = 0.616). In patients suffering from axial-type symptoms (i.e., mechanical back pain), 63% who received tamsulosin and 18% from the control group (P = 0.048) developed POUR. CONCLUSION Overall, there was no statistically significant difference in the rates of developing POUR among patients in either group. POUR is caused by a variety of factors, and further studies are needed to shed light on its etiology.
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Affiliation(s)
- Azam Basheer
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Alsaidi
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mokbel Chedid
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Donald Seyfried
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Affiliation(s)
- Christina M Papageorge
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center - H4, Madison, WI 53792, USA
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center - H4, Madison, WI 53792, USA.
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35
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Lee CY, Kim CS, Cho WJ. Characteristics of urinary retention in female inpatients managed with medical treatments. Korean J Urol 2015; 56:817-22. [PMID: 26682022 PMCID: PMC4681759 DOI: 10.4111/kju.2015.56.12.817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose We aimed to analyze the characteristics of urinary retention (UR) in female inpatients managed with medical treatments. Materials and Methods We retrospectively analyzed the medical records of female inpatients referred to the department of urology for UR at our institution from January 2009, to December 2014. UR was defined as a difficulty in self-voiding despite a sufficient urine volume or >300-mL postvoid residual. The data included patients' age, body mass index (BMI), ambulatory status, medical and surgical history, classes of taking drugs, and urinary tract infection. Results A total of 182 women were included as retention group, mean age of 72.64±12.94 years and BMI of 22.94±3.10 kg/m2. In the chi-square analysis, cardiovascular disorders (p=0.000), diabetes mellitus (p=0.008), metastatic malignancy (p=0.008), chronic renal disorders (p=0.028) were found significantly. In the multiple logistic regression analysis, cardiovascular disorders (p=0.002; odds ratio [OR], 0.491), metastatic malignancy (p=0.013; OR, 2.616) were found to increase the risk of UR. The most common surgical history was anti-incontinence surgery (7.2%). In term of medication use, the most prescribed agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (53.8%). The patients taking multiple drugs with antimuscarinic effects except of NSAIDs, narcotics and diuretics were 48 (26.4%). Urinary tract infection was identified in 43 patients (23.6%). Conclusions UR in females managed with medical treatments could be occurred occasionally. We think that thorough attentions are needed for UR to patients with cardiovascular disorders including diabetes mellitus, metastatic malignancy, chronic renal disorders urinary tract infection, and more careful interests when managing with drugs with antimuscarinic effects.
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Affiliation(s)
- Chang Yong Lee
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Chul Sung Kim
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Won Jin Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
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