Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients

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.

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Postoperative Urinary Retention: Risk Factors, Bladder Filling Rate and Time to Catheterization: An Observational Study as Part of a Randomized Controlled Trial

10.21203/rs.3.rs-34604/v2 ◽

2020 ◽

Author(s):

Tammo Allie Brouwer ◽

Eric N van Roon ◽

Peter F.W.M. Rosier ◽

Cor J Kalkman ◽

Nic Veeger

Keyword(s):

Risk Factors ◽

Spinal Anesthesia ◽

Urinary Retention ◽

Bladder Capacity ◽

Surgical Patients ◽

Bladder Volume ◽

Urinary Catheterization ◽

Filling Rate ◽

Postoperative Urinary Retention ◽

Bladder Filling

Abstract BackgroundKnowledge 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.MethodsRisk 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.ResultsSpinal 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 <500mL (RR 6.7), duration of surgery ≥60 minutes (RR 5.5), first scanned bladder volume at the Post Anesthesia Care Unit ≥250mL (RR 2.1), and age ≥60 year (RR 2.0). Urine production varied from 100 to 200mL/hour. Catheterization or spontaneous voiding took place approximately 4 hours postoperatively.ConclusionSpinal 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 hours) 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.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 (https://doi.org/10.1186/ISRCTN97786497). Registered 18 July 2011 -Retrospectively registered. The original study started May 19th, 2008, and ended April30th, 2009, when the last patient was included.

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Postoperative urinary retention in general surgical patients

British Journal of Surgery ◽

10.1002/bjs.1800751128 ◽

1988 ◽

Vol 75 (11) ◽

pp. 1141-1143 ◽

Cited By ~ 73

Author(s):

S. Stallard ◽

S. Prescott

Keyword(s):

Urinary Retention ◽

Surgical Patients ◽

Postoperative Urinary Retention

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Electroacupuncture for Bladder Function Recovery in Patients Undergoing Spinal Anesthesia

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/892619 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Yinqiu Gao ◽

Xinyao Zhou ◽

Xichen Dong ◽

Qing Jia ◽

Shen Xie ◽

...

Keyword(s):

Adverse Events ◽

Spinal Anesthesia ◽

Urinary Retention ◽

Urine Volume ◽

Bladder Function ◽

Control Group ◽

Postoperative Urinary Retention ◽

Function Recovery ◽

Significant Difference ◽

Secondary Endpoints

Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function.Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary endpoints included time to spontaneous micturition, voided volume, and adverse events.Results. All patients (31 in electroacupuncture group and 30 in control group) completed the evaluation. During postoperative follow-up, patients in electroacupuncture group presented a significant lower proportion of bladder overdistension than counterparts in control group (16.1% versus 53.3%,P< 0.01). However, no significant difference was found in incidence of postoperative urinary retention between the two groups (0% versus 6.7%,P> 0.05). Furthermore, a shorter time to spontaneous micturition was found in electroacupuncture group compared to control group (228 min versus 313 min,P< 0.001), whereas urine volume and adverse events had no significant difference between the two groups.Conclusions. Electroacupuncture reduced the proportion of bladder overdistension and shortened the time to spontaneous micturition in patients undergoing spinal anesthesia. Electroacupuncture may be a therapeutic strategy for postanesthetic bladder dysfunction.

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