Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial

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

10.21203/rs.3.rs-34604/v1 ◽

2020 ◽

Author(s):

Tammo Allie Brouwer ◽

Eric N van Roon ◽

Cor J Kalkman ◽

Nic Veeger

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Lower Urinary Tract ◽

Bladder Capacity ◽

Surgical Patients ◽

Urinary Catheterization ◽

Bladder Filling ◽

Urine Production ◽

The Individual ◽

Lower Urinary

Abstract Background If risk factors for postoperative urinary catheterization are known adverse events to the lower urinary tract may be prevented. Therefore, postoperative surgical patients were assessed for risk factors for urinary catheterization, for speed of bladder filling and for time till catheterization or spontaneous voiding. The individual maximum bladder capacity was used as threshold for urinary catheterization. Methods In this prospective observational study 936 general surgical patients were analyzed for risk factors for urinary catheterization. Patients were 18 years or older and were operated under general or spinal anesthesia without the need for an intra-operative indwelling urinary catheter. The maximum bladder capacity was measured at home by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively bladder volumes were hourly assessed with ultrasound. Patients were catheterized after reaching their maximum bladder capacity and being unable to void. Speed of bladder filling and time to catheterization were then calculated. Results Spinal anesthesia was the main independent modifiable risk factor for urinary catheterization (hyperbaric bupivacaine RR 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 scan at Post Anesthesia Care Unit ≥250mL (RR 2.1) and age ≥60 (RR 2.0). Urine production varied between 100mL to 200mL/hour. Catheterization or spontaneous voiding happened around 4 hours postoperatively. Conclusion Using the individual maximum bladder capacity, next to the other risk factors, identifies patients at risk for urinary catheterization. These factors should be taken in account whether or not to catheterize the patient to prevent unnecessary urinary catheterization. Considering urine production and maximum bladder capacities, the bladder should be scanned at least within 3 hours postoperatively to prevent overdistention and damage to the lower urinary tract.

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

Egyptian Journal of Anaesthesia ◽

10.1016/j.egja.2014.12.002 ◽

2015 ◽

Vol 31 (1) ◽

pp. 65-69 ◽

Cited By ~ 4

Author(s):

Alaa Abdel aziz Niazi ◽

Mohamed Abdel aziz Taha

Keyword(s):

Spinal Anesthesia ◽

Urinary Retention ◽

Surgical Patients ◽

Postoperative Urinary Retention

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Incidence and Risk Factors for Postoperative Urinary Retention in Total Hip Arthroplasty Performed Under Spinal Anesthesia

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.07.009 ◽

2017 ◽

Vol 32 (12) ◽

pp. 3748-3751 ◽

Cited By ~ 13

Author(s):

Charles M. Lawrie ◽

Alvin C. Ong ◽

Victor H. Hernandez ◽

Samuel Rosas ◽

Zachary D. Post ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Spinal Anesthesia ◽

Urinary Retention ◽

Hip Arthroplasty ◽

Postoperative Urinary Retention ◽

Total Hip

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Postoperative Bladder Catheterization Based on Individual Bladder Capacity

Anesthesiology ◽

10.1097/aln.0000000000000507 ◽

2015 ◽

Vol 122 (1) ◽

pp. 46-54 ◽

Cited By ~ 11

Author(s):

Tammo A. Brouwer ◽

Peter F. W. M. Rosier ◽

Karel G. M. Moons ◽

Nicolaas P. A. Zuithoff ◽

Eric N. van Roon ◽

...

Keyword(s):

Spinal Anesthesia ◽

Bladder Capacity ◽

Bladder Volume ◽

Lower Urinary Tract Dysfunction ◽

Ultrasound Measurement ◽

Control Group ◽

Postoperative Urinary Retention ◽

Bladder Catheterization ◽

Index Group ◽

Safe Approach

Abstract Background: Untreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient’s own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization. Methods: Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization. Results: The average MBC in the control group was 582 ml (±199 ml) and in the index group 611 ml (±209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group. Conclusions: In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.

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Incidence and Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Fusion

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001202 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

John J. Bowman ◽

Charles C. Edwards ◽

Clayton Dean ◽

Justin Park ◽

Charles C. Edwards

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Urinary Retention ◽

Spine Fusion ◽

Postoperative Urinary Retention ◽

Lumbar Spine Fusion

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Risk Factors for Postoperative Urinary Retention in Surgical Population: A Prospective Cohort Study

Journal of Urological Surgery ◽

10.4274/jus.galenos.2020.3544 ◽

2020 ◽

Vol 7 (2) ◽

pp. 144-148

Author(s):

Meltem Çakmak ◽

Murside Yıldız ◽

İlker Akarken ◽

Yücel Karaman ◽

Özgür Çakmak

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Urinary Retention ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Urinary Retention

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Risk Factors for Postoperative Urinary Tract Infection and Urinary Retention in Patients Undergoing Surgery for Colorectal Cancer

The American Surgeon ◽

10.1177/000313481207801020 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1100-1104 ◽

Cited By ~ 23

Author(s):

Celeste Y. Kang ◽

Obaid O. Chaudhry ◽

Wissam J. Halabi ◽

Vinh Nguyen ◽

Joseph C. Carmichael ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Urinary Tract Infection ◽

Logistic Regression ◽

Urinary Tract ◽

Tract Infection ◽

Hospital Mortality ◽

Urinary Retention ◽

Surgical Patients ◽

Independent Risk Factors

The aim of this study was to analyze risk factors for postoperative urinary tract infection (UTI) and urinary retention (UR) in patients with colorectal cancer. Using Nationwide Inpatient Sample 2006–2009, a retrospective analysis of surgical patients with colorectal cancer was conducted. Patients were stratified into groups, with or without UTI/UR. The LASSO algorithm for logistic regression identified independent risk factors. A total of 93,931 surgical patients with colorectal cancer were identified. The incidences of UTI and UR were 5.91 and 2.52 per cent, respectively. Overall in-hospital mortality was 2.68 per cent. The UTI group demonstrated significantly higher in-hospital mortality rates compared with those without. Both UTI and UR groups were associated with prolonged hospital stay and increased hospital charge. Multivariate logistic regression analysis revealed age older than 60 years, females, anemia, congestive heart failure, coagulopathy, diabetes with chronic complications, fluid and electrolyte, paralysis, pulmonary circulation disorders, renal failure, and weight loss were independent risk factors of UTI. Age older than 60 years, male gender, rectal and rectosigmoid cancers, and postoperative anastomotic leakage and ileus were independent risk factors for UR. Postoperative UTI increases in-house mortality. Postoperative UTI/UR in patients with colorectal cancer increases length of stay and hospital charges. Knowledge of these specific risk factors for UTI and UR is needed to counsel patients and prevent these complications in this high-risk population.

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