1
|
Yang M, Zhu L, Yao H, Chen Y, Liu Z. Effects of electroacupuncture on chronic urinary retention after pelvic or lumbosacral tumor resection surgeries: a retrospective cohort study. Transl Androl Urol 2024; 13:397-405. [PMID: 38590962 PMCID: PMC10999027 DOI: 10.21037/tau-23-468] [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: 09/12/2023] [Accepted: 01/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background Chronic urinary retention (CUR) resulting from lower motor neuron lesions (LMNL) is a medical condition secondary to pelvic or lumbosacral tumor resection surgeries. Electroacupuncture (EA) is proved to be effective and safe in treating certain lower urinary tract disorders. However, the clinical benefit and optimal duration of EA treatment for CUR following LMNL remain unknown. Methods Using a retrospective cohort design, 20 eligible patients diagnosed with CUR resulting from LMNL secondary to pelvic or lumbosacral tumor resection surgeries were included from March 1, 2017, to June 30, 2020. The patients were treated by EA three times a week for 2 to 12 weeks and followed up for 24 weeks after treatment. The electric stimulators with a 5-Hz continuous wave (5-10 mA intensity) were separately connected to bilateral Ciliao (BL32), bilateral Zhongliao (BL33), and bilateral Huiyang (BL35), and stimulators with a 10-Hz continuous wave (1-2 mA intensity) were connected to bilateral Sanyinjiao (SP6). Current intensity was adjusted according to the patients' individual tolerance. The median follow-up was 32 weeks (range, 26-36 weeks). Responders were defined as patients whose post-void residuals (PVR) reduced by 50% or more from baseline. Adverse event was recorded. Results Totally 20 patients [mean (standard deviation) age, 48.1 (15.5) years; 9 men (45.0%); 11 women (55.0%)] were included. Of the 20 patients, 14 (70.0%) had responded to EA treatment and stopped catheterization for achieving satisfactory spontaneous urination (PVR <100 mL without complications), 7 (35.0%) had complete resolution (90-100% reduction in PVR from baseline), and 13 (65.0%) scored 1 (much better) or 2 (moderately better) in the Patient Global Impression of Improvement (PGI-I) assessment. Moreover, 6 (30.0%) patients had responded within 4 weeks of EA treatment. According to Kaplan-Meier survival curve, we found that more than 50% patients could respond to EA treatment within 8 weeks or longer. None of the responders had ever experienced relapse in 24 weeks after EA treatment ended. None of the patients manifested urinary tract infection (UTI), newly diagnosed hydroureter or hydronephrosis. One patient diagnosed with hydronephrosis at baseline recovered after 12-week EA treatment. Two patients with UTI at baseline were prescribed antibiotics and did not present UTI again during the follow-up. Conclusions EA could be a promising treatment option for CUR caused by LMNL following pelvic or lumbosacral tumor resection surgeries, with long-term effects and a good safety profile. The optimal duration of EA should be of 8 weeks at least. But this was a retrospective cohort study of a small sample size, so future studies are needed to investigate EA in larger populations in randomized controlled trials.
Collapse
Affiliation(s)
- Min Yang
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lili Zhu
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Yao
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Chen
- Beijing Houpo Chinese Medicine Institute, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Chan K, Keane A, Pradhan S, King T, Moroco A, Goyal N, Choi KY. Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery. Ann Otol Rhinol Laryngol 2024; 133:284-291. [PMID: 37902061 PMCID: PMC10865755 DOI: 10.1177/00034894231208256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology. METHODS A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors. RESULTS Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P = .04) and postoperative (P = .01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P < .001). Only one patient (0.5%) developed a urinary tract infection (UTI). CONCLUSION Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery.
Collapse
Affiliation(s)
- Kimberly Chan
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Allison Keane
- Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Tonya King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Annie Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Karen Y. Choi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
3
|
Jasinski J, Tong D, Yoon E, Claus C, Lytle E, Houseman C, Bono P, Soo TM. Preventing Postoperative Urinary Retention (POUR) in Patients Undergoing Elective Lumbar Surgery: A Quality Improvement Project. Qual Manag Health Care 2023; 32:270-277. [PMID: 36913773 DOI: 10.1097/qmh.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS). METHODS A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant. RESULTS We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P = .007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P = .017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P = .015). Diabetes (OR = 2.25, CI 1.03-4.92, P = .04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P = .002) were independently associated with increased odds of developing POUR. CONCLUSIONS After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR.
Collapse
Affiliation(s)
- Jacob Jasinski
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Nollen JM, Brunsveld-Reinders AH, Peul WC, van Furth WR. Patient perspectives on indwelling urinary catheters and fluid balances after transsphenoidal pituitary surgery: a qualitative study. BMJ Open 2023; 13:e069598. [PMID: 36940939 PMCID: PMC10030659 DOI: 10.1136/bmjopen-2022-069598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES To explore the perceptions and experiences of patients who underwent transsphenoidal pituitary gland and (para)sellar tumour surgery regarding indwelling urinary catheters (IDUCs) and the postoperative fluid balance. DESIGN Qualitative study using semistructured interviews based on the attitudes, social influence and self-efficacy model and expert knowledge. PARTICIPANTS Twelve patients who underwent transsphenoidal pituitary gland tumour surgery and received an IDUC during or after surgery. SETTING One patient was interviewed in the endocrinology outpatient clinic and 11 patients were interviewed on the neurosurgery ward. RESULTS Five major themes emerged: (1) conflicting information and preoperative expectations, (2) IDUCs perceived as patient-friendly during bedrest, particularly for women, (3) little room for patients' opinions, (4) physical and emotional limitations and (5) fluid balance causes confusion. Information regarding IDUC placement and fluid balance given to patients both preoperatively and postoperatively did not meet their expectations, which led to confusion and uncertainty. The IDUC was perceived as preferable if bedrest was mandatory, preferred particularly by women. Patient could not mobilise freely due to the IDUC and felt ashamed, judged by others and dependent on nurses. CONCLUSIONS This study provides insight into the challenges patients experience in relation to the IDUC and fluid balance. Perceptions on the necessity of an IDUC varied among patients and were influenced by both physical and emotional impediments. A clear, frequent and daily communication between healthcare professionals and patients to evaluate IDUC and fluid balance use is necessary to increase patient satisfaction.
Collapse
Affiliation(s)
- Jeanne-Marie Nollen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Prevent postoperative urinary retention in day surgery adult patients: evidence-based quality improvement project. INT J EVID-BASED HEA 2022; 20:344-354. [DOI: 10.1097/xeb.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Effect of external urinary collection device implementation on female surgical patients. Infect Dis Health 2022; 27:227-234. [PMID: 35753991 DOI: 10.1016/j.idh.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention reports that catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection. Female external urinary collection devices (EUCDs) may be an alternative to indwelling urethral catheters (IUCs), thereby decreasing CAUTIs. However, no study has demonstrated that EUCDs can help reduce CAUTIs in female surgical patients. We sought to compare CAUTI rate and the median number of days an IUC was used before and after availability of this female EUCD for surgical patients. METHODS A retrospective analysis of adult female surgical patients admitted to a single academic institution who received an IUC and/or EUCD was performed. Patients who received an IUC three months before (PRE) EUCD availability (08/2017-10/2017) were compared to patients receiving an IUC and/or EUCD 12 months after (POST) (11/2017-11/2018). RESULTS From 906 surgical patients receiving an IUC/EUCD, 127 received an EUCD in the POST cohort. Compared to the PRE, the POST had a higher rate of CAUTIs (infections per 1000 catheter days, 11.2 vs. 4.6, p = 0.017) and overall UTI rate (infections per 1000 catheter days, 5.4 vs. 4.8, p = 0.036), whereas IUC days were similar between cohorts (median, two vs. two days, p = 0.18). The POST cohort rate of EUCD UTI was 4.6 infections per 1000 device days. CONCLUSION While EUCDs appear to be a promising alternative to IUCs for female surgical patients, this study found increased CAUTIs after introduction of an EUCD. Further research is needed to clarify if female EUCDs are effective in decreasing CAUTI prior to widespread adoption.
Collapse
|
9
|
Tan CMP, Kaliya-Perumal AK, Ho GWK, Oh JYL. Postoperative Urinary Retention Following Thoracolumbosacral Spinal Fusion: Prevalence, Risk Factors, and Outcomes. Cureus 2021; 13:e19724. [PMID: 34934587 PMCID: PMC8684364 DOI: 10.7759/cureus.19724] [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] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Postoperative urinary retention (POUR) is an often-underestimated common complication following spine surgery, and it is essential to avoid its untoward long-term consequences. Besides, a dilemma exists regarding the appropriate timing for the postoperative removal of indwelling catheter (IDC). Hence, we aim to describe the prevalence, risk factors, and outcomes of POUR and also come up with recommendations for the removal of IDC. Methods Electronic records of patients who underwent elective thoracolumbosacral spinal fusion surgery from January 2017 to December 2019 were retrospectively reviewed. Excluded were those who underwent fusion for indications such as trauma, cauda equina syndrome, infection, and malignancy. Both surgery-related and patient-related risk factors were tabulated, and their association with the likely development of POUR was assessed by univariate and multivariate analysis. Results One hundred sixty-eight patients (median age=64.1 years; 58.9% female) were included, with the incidence of POUR being 7.8%. Our findings suggest surgery-related factors, both intra- and postoperative, including operating time (p=0.008), anesthetic time (p=0.005), number of fusion levels (p<0.001), mobilization status prior to trial off catheter (TOC; p=0.021), and TOC timing (p=0.029) may have an association with POUR. In addition, patient-related factors, including the use of beta-blockers (p=0.020) and pre-operative mobility status (p<0.001), may also be associated with the likely development of POUR. Conclusion POUR seems to be a frequent complication following thoracolumbosacral spinal fusion surgery, which was found to have an association with some surgery-related and patient-related factors. While most of these factors are non-modifiable, certain modifiable risk factors provide the surgeon an opportunity to prevent POUR. Considering these factors, we recommend appropriate and timely mobilization of the patient prior to removal of IDC, which is to be performed preferably in the daytime.
Collapse
Affiliation(s)
| | | | - Glen Wen Kiat Ho
- Orthopaedic Surgery, Yong Loo Lin School of Medicine, Singapore, SGP
| | | |
Collapse
|
10
|
Bowman JJ, Edwards CC, Dean C, Park J, Edwards CC. Incidence and Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Fusion. Clin Spine Surg 2021; 34:E397-E402. [PMID: 34050045 DOI: 10.1097/bsd.0000000000001202] [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] [Received: 05/02/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a prospective cohort study (observational-retrospective chart review). OBJECTIVE The objective of this study was to determine clinical rates and correlations of postoperative urinary retention (POUR) in elective spine decompression and fusion procedures. SUMMARY OF BACKGROUND DATA POUR is a common postoperative complication that often has a major adverse impact on a patient's recovery from elective lumbar spine surgery. The etiology of POUR in most cases is unknown. Patients undergoing lumbar spine surgery are considered to be at increased risk for POUR due to prone positioning during surgery and intraoperative cauda equina nerve root manipulation. Current studies reporting on POUR after elective spine surgery provide limited insight regarding risk factors and effective prevention strategies for this at-risk population. The purpose of this study is to identify risk factors for POUR after elective lumbar spine surgery and strategies for reducing its incidence. MATERIALS AND METHODS Two hundred consecutive patients aged 50 years or older undergoing combined lumbar decompression and fusion procedures over a 5-month period at a single institution were prospectively observed. Demographic and clinical data were prospectively recorded, including: medical history, surgical data, medications administered, complications, and postoperative hospital course. Factors correlating with POUR through a univariate analysis with P≤0.20 were considered for multivariate analysis. RESULTS POUR occurred in 19 of 200 patients. Those with POUR were more likely to be male (20% vs. 4%, odds ratio=6.2). Administration of scopolamine (P=0.02), neostigmine (P=0.01), and the total number of levels operated on (P=0.02) were found to be independent risk factors for the development of POUR. Length of surgery, surgical level, the performance of an interbody fusion did not have a bearing on the development of POUR (P>0.05). DISCUSSION We describe a single institution's experience of POUR incidence in 200 consecutive patients aged 50 years or older undergoing single or multilevel lumbar spine fusion procedures by 1 of 4 surgeons. Specific demographic and clinical risk factors were identified and a codified classification for POUR in a surgical population is presented.The results of this study will help clinicians appropriately counsel patients undergoing elective lumbar fusion about the potential development of POUR. The perioperative administration of scopolamine and neostigmine should be cautiously considered in men over 50 years of age due to the increased POUR risk. CONCLUSIONS Perioperative scopolamine and neostigmine administration in men over 50 should be avoided when possible to minimize the risk of POUR. LEVEL OF EVIDENCE Level III.
Collapse
|
11
|
Leitner L, Wanivenhaus F, Bachmann LM, Liechti MD, Aguirre JA, Farshad M, Kessler TM. Bladder management in patients undergoing spine surgery: An assessment of care delivery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 6:100059. [PMID: 35141624 PMCID: PMC8820009 DOI: 10.1016/j.xnsj.2021.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. METHODS Preoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. RESULTS Hundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p < 0.05). In the 46 preoperatively catheterized patients, re-catheterization was required in 6 (13%). In a fairly homogenous subgroup of 72 patients with a probability of PUC between 15 and 40%, no significant association between intraoperative urethral catheter-free management and the occurrence of PUC was found (odds ratio 2.09, 95% confidence interval 0.69 to 6.33; p = 0.193). CONCLUSIONS In case of postoperative PVR monitoring allowing de novo catheterization as appropriate, urethral catheter-free management seems to be a valuable option in spine surgery since it does not to increase PUC but minimizes unnecessary catheterizations with their related complications.
Collapse
Affiliation(s)
- Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Florian Wanivenhaus
- Spine Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - José A. Aguirre
- Department of Anesthesia, Intensive Care and Pain Therapy, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mazda Farshad
- Spine Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
12
|
Risk Factors Associated With Development of Urinary Retention Following Posterior Lumbar Spinal Fusion: Special Attention to the Use of Glycopyrrolate in Anesthesia Reversal. Spine (Phila Pa 1976) 2021; 46:E133-E138. [PMID: 32890297 DOI: 10.1097/brs.0000000000003678] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The study is designed as a retrospective cohort study. OBJECTIVE The aim of this study was to identify modifiable and nonmodifiable risk factors of postoperative urinary retention in spine surgery patients. SUMMARY OF BACKGROUND DATA Postoperative urinary retention is a common complication in patients undergoing operative procedures requiring anesthesia. Current studies have shown significant risk factors for postoperative urinary retention, but most are nonmodifiable and subsequently of limited usefulness in preventing this complication. Several new studies have shown possible modifiable risk factors, but current data are inconsistent in terms of their statistical significance. METHODS A total of 814 consecutive patients who underwent open posterior lumbar laminectomy and fusion were included in the retrospective cohort study. Pre, intra-, and postoperative characteristics were collected in all patients to identify risk factors for postoperative urinary retention. RESULTS Glycopyrrolate use (odds ratio [OR] 2.60; P = 0.001), decreased body mass index (OR 0.96; P = 0.018), previous diagnosis of benign prostate hyperplasia (OR 3.34; P ≤ 0.001), and postoperative urinary tract infection (OR 5.60, P = 0.005) were associated with postoperative urinary retention. Previous history of lumbar spine surgery (OR 0.55; P = 0.019) was associated with decreased rates of postoperative urinary retention. CONCLUSION Glycopyrrolate use, benign prostate hyperplasia, and postoperative urinary tract infection were independent risk factors for postoperative urinary retention. The use of glycopyrrolate is a potentially modifiable risk factor for postoperative urinary retention.Level of Evidence: 3.
Collapse
|
13
|
Brouwer TA, van Roon EN, Rosier PFWM, Kalkman CJ, Veeger N. Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial. Perioper Med (Lond) 2021; 10:2. [PMID: 33397468 PMCID: PMC7784306 DOI: 10.1186/s13741-020-00167-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Knowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or catheterization. We used the patients previously determined individual maximum bladder capacity as threshold for urinary catheterization. METHODS Risk factors for urinary catheterization were prospectively determined in 936 general surgical patients. Patients were at least 18 years of age and operated under general or spinal anesthesia without the need for an indwelling urinary catheter. Patients measured their maximum bladder capacity preoperatively at home, by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively, bladder volumes were assessed hourly with ultrasound. When patients reached their maximum bladder capacity and were unable to void, they were catheterized by the nursing staff. Bladder filling rate and time to catheterization were determined. RESULTS Spinal anesthesia was the main independent modifiable risk factor for urinary catheterization (hyperbaric bupivacaine, relative risk 8.1, articaine RR 3.1). Unmodifiable risk factors were a maximum bladder capacity < 500 mL (RR 6.7), duration of surgery ≥ 60 min (RR 5.5), first scanned bladder volume at the Post Anesthesia Care Unit ≥250mL (RR 2.1), and age ≥ 60 years (RR 2.0). Urine production varied from 100 to 200 mL/h. Catheterization or spontaneous voiding took place approximately 4 h postoperatively. CONCLUSION Spinal anesthesia, longer surgery time, and older age are the main risk factors for urinary retention catheterization. Awareness of these risk factors, regularly bladder volume scanning (at least every 3 h) and using the individual maximum bladder capacity as volume threshold for urinary catheterization may avoid unnecessary urinary catheterization and will prevent bladder overdistention with the attendant risk of lower urinary tract injury. TRIAL REGISTRATION Dutch Central Committee for Human Studies registered trial database: NL 21058.099.07. Current Controlled Trials database: Preventing Bladder Catheterization after an Operation under General or Spinal Anesthesia by Using the Patient's Own Maximum Bladder Capacity as a Limit for Maximum Bladder Volume. ISRCTN97786497 . Registered 18 July 2011 -Retrospectively registered. The original study started 19 May 2008, and ended 30 April 2009, when the last patient was included.
Collapse
Affiliation(s)
- Tammo A Brouwer
- Department of Anesthesiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901, BR, Leeuwarden, The Netherlands.
| | - E N van Roon
- Department of Pharmacotherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - P F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C J Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Veeger
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
14
|
Kopel J, Sharma DP. Spinal surgery and urinary retention: A review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820916932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Postoperative urinary retention is a common complication for patients recovering from general anesthesia or invasive surgery near the spinal column. However, no study has systematically reviewed the incidence of postoperative urinary retention for spinal surgeries performed at the cervical, thoracic, or lumbar spinal regions. In this review, we critically analyze and summarize the known literature on the incidence and risk factors associated with postoperative urinary retention after spinal surgery. Methods: A comprehensive literature review was performed at the end of September 2019 within the PubMed database. Results: The average incidence of postoperative urinary retention from nine of the 10 studies was 17.2% with one paper that did not report on postoperative urinary retention incidence. Furthermore, age, male gender, location and history of spinal surgery, duration of surgery, benign prostatic hypertrophy, and Foley catheter were reported as major risk factors for postoperative urinary retention and spinal surgery. Conclusion: Overall, spinal cord and postoperative urinary retention remains a poorly understood area requiring further investigation into the incidence, risk factors, and surgical methods influence postoperative urinary retention and post-operative outcomes. We believe an overview of such data can help revise guidelines for the management of postoperative urinary retention and raise awareness of its prevalence in elderly patients undergoing spinal surgery. Level of evidence: Not applicable for this multicentre audit.
Collapse
Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, United States of America
| | - Dr Pranav Sharma
- Staff Physician, Department of Urology, Texas Tech University Health Sciences Center, Lubbock, United States of America
| |
Collapse
|
15
|
Zakaria HM, Lipphardt M, Bazydlo M, Xiao S, Schultz L, Chedid M, Abdulhak M, Schwalb JM, Nerenz D, Easton R, Chang V. The Preoperative Risks and Two-Year Sequelae of Postoperative Urinary Retention: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC). World Neurosurg 2020; 133:e619-e626. [DOI: 10.1016/j.wneu.2019.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lee S, Kim CH, Chung CK, Park SB, Yang SH, Kim SH, Kang S, Lee JH, Choi Y. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis. Spine J 2017; 17:469-477. [PMID: 27012647 DOI: 10.1016/j.spinee.2016.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/25/2016] [Accepted: 03/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients. PURPOSE The aim of the present study was to determine the incidence of and risk factors for POUR. STUDY DESIGN/SETTING This is a retrospective nested case-control study. PATIENT SAMPLE A total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed. OUTCOME MEASURES A multivariable logistic model was utilized to identify risk factors. METHODS A systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4-6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100 mL for more than 2 days after surgery. RESULTS The incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029-1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001-1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684). CONCLUSION POUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries.
Collapse
Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, 875 haeun-daero, Haeundae-gu, Busan, 612-896, South Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Neuroscience Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE
| | - Soo Hyun Kim
- Department of Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soohee Kang
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ju Hee Lee
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| |
Collapse
|
18
|
Abstract
Urinary retention is an important and potentially avoidable postoperative complication. Identifying risk factors for retention is important given expedient bladder decompression is important for long-term outcomes. Age, benign prostatic hyperplasia, and lower urinary tract symptoms are patient factors that predispose to retention. Surgery-related factors include operative time, intravenous fluid administration, type of anesthesia, and procedure type. The mainstay for treatment in the acute setting is Foley catheter placement. Starting alpha-blockers in men is also indicated as they increase voiding trial success. Long-term solutions for chronic retention include a variety of surgeries, with transurethral prostatectomy as the gold standard.
Collapse
Affiliation(s)
- Urszula Kowalik
- University of Vermont Medical Center, 111 Colchester Avenue, Mailstop 222WP2, Burlington, VT 05401, USA
| | - Mark K Plante
- Division of Urology, Department of Surgery, University of Vermont Medical Center, University of Vermont College of Medicine, 111 Colchester Avenue, Mailstop 320FL4, Burlington, VT 05401, USA.
| |
Collapse
|
19
|
Intramuscular Administration of Drotaverine Hydrochloride Decreases Both Incidence of Urinary Retention and Time to Micturition in Orthopedic Patients under Spinal Anesthesia: A Single Blinded Randomized Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:926953. [PMID: 26185766 PMCID: PMC4491383 DOI: 10.1155/2015/926953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022]
Abstract
Purpose. Postoperative urinary retention (POUR) increases the duration of hospitalization and frequency and risk of urinary bladder catheterization. The objective of this study was to analyze the efficacy of intramuscularly administered drotaverine hydrochloride in the prevention of POUR in orthopedic patients. Methods. Two hundred and thirty patients 17–40 years of age undergoing lower limb orthopedic procedures under spinal anesthesia were enrolled in the study. The study group received 40 mg of drotaverine hydrochloride intramuscularly; the second group was the control. The main outcome measure was (1) the time to micturition and (2) the incidence of urinary bladder catheterization and time to catheterization. Results. Two hundred and one patients of 230 enrolled participants completed the study. Compared to the control group, the male patients in study group exhibited a shorter time to spontaneous micturition (441 versus 563 minutes, 95% CI of the difference of means between 39 and 205 minutes) and a lower incidence of urinary bladder catheterization (4/75 versus 10/54) (RR 0.29, 95% CI: 0.1–0.87; P = 0.0175). Conclusions. Intramuscular administration of drotaverine hydrochloride decreased the time to spontaneous micturition and decreased the incidence of urinary bladder catheterization in male patients who underwent orthopedic surgery under spinal anesthesia. This trial is registered with NCT02026427.
Collapse
|
20
|
Afazel MR, Jalali E, Sadat Z, Mahmoodi H. Comparing the Effects of Hot Pack and Lukewarm-Water-Soaked Gauze on Postoperative Urinary Retention; A Randomized Controlled Clinical Trial. Nurs Midwifery Stud 2014; 3:e24606. [PMID: 25741518 PMCID: PMC4348728 DOI: 10.17795/nmsjournal24606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/22/2014] [Accepted: 11/23/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Urinary retention is a common postoperative complication that mandates urinary catheterization. Urinary catheterization is associated with different physical, mental, and financial problems for both patients and healthcare systems. The patient inconvenience, urinary tract infections, and increase in hospital stay and expenses are common problems of urinary retention and urinary catheterization. Therefore, alternative ways of relieving urinary retention, preferably noninvasive interventions, are of great interest. Objectives: The aim of this study was to compare the effects of placing hot pack and lukewarm-water-soaked gauze on the suprapubic region on male patients with postoperative urinary retention. Patients and Methods: This was a three-group, randomized, controlled trial. A convenience sample of 126 male patients who had undergone general, orthopedic, or urologic surgeries were recruited. The block randomization method was used for allocating patients to either the two experimental groups (the hot pack and the lukewarm-water-soaked gauze groups) or the control one. Patients in the experimental groups were treated by placing either hot pack or lukewarm-water-soaked gauze on the suprapubic region. All patients were monitored for 20 minutes for urinary retention relief. If they did not experience urinary retention relief (starting urine flow and bladder evacuate), urinary catheterization would be performed. The data was collected using information sheet. Elimination of urinary retention was compared among study groups. The one-way analysis of variance and the Chi-square tests were used for analyzing data. Results: Respectively, 59.5%, 71.4%, and 7.1% of patients in the hot pack, the soaked gauze, and the control groups experienced relief from urinary retention and the bladder was emptied. There was a significant difference among study groups in percentage of patients who experienced urinary retention relief. However, the difference between the two experimental groups was not significant. The time to urinary retention relief in hot pack, soaked gauze, and control groups was 15.45 ± 3.15, 13.83 ± 3.80, and 14.59 ± 3.29 minutes, respectively. The difference among the study groups in time to urinary retention relief was not statistically significant. Conclusions: Both the lukewarm-water-soaked gauze and the hot pack techniques had significant effects on postoperative urinary retention and significantly reduced the need for urinary catheterization. Using these two simple and cost-effective techniques for managing postoperative urinary retention is recommended.
Collapse
|