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

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

Perioperative Medicine ◽

10.1186/s13741-020-00167-z ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Tammo A. Brouwer ◽

E. N. van Roon ◽

P. F. W. M. Rosier ◽

C. J. Kalkman ◽

N. 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 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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Faculty Opinions recommendation of Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1157523.617702 ◽

2009 ◽

Author(s):

Peter Gilling ◽

Liam Wilson

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Benign Prostatic Hyperplasia ◽

Lower Urinary Tract ◽

Healthy Aging ◽

Prostatic Hyperplasia ◽

Community Based ◽

Urinary Tract Symptoms ◽

Aging Men ◽

Lower Urinary

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Risk Factors for Lower Urinary Tract Symptoms in a Population-based Sample of African-American Men

American Journal of Epidemiology ◽

10.1093/aje/kwg051 ◽

2003 ◽

Vol 157 (10) ◽

pp. 906-914 ◽

Cited By ~ 144

Author(s):

M. A. Joseph

Keyword(s):

Risk Factors ◽

African American ◽

Urinary Tract ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

African American Men ◽

Population Based ◽

Urinary Tract Symptoms ◽

Lower Urinary

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Study of prevalence, treatment-seeking behavior, and risk factors of women with lower urinary tract symptoms in Northern Malaysia

Urology ◽

10.1016/j.urology.2006.05.021 ◽

2006 ◽

Vol 68 (4) ◽

pp. 751-758 ◽

Cited By ~ 8

Author(s):

Bee Yean Low ◽

Men Long Liong ◽

Kah Hay Yuen ◽

Wooi Loong Chong ◽

Christopher Chee ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

Treatment Seeking ◽

Urinary Tract Symptoms ◽

Seeking Behavior ◽

Lower Urinary

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133: Painful Symptoms and Decreased Bladder Capacity are Significant Predictors of Cystoscopic Glomerulation Suggestive of Interstitial Cystitis in Elderly Male Patients with Lower Urinary Tract Symptoms

The Journal of Urology ◽

10.1016/s0022-5347(18)30398-7 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 46-46

Author(s):

Munekado Kojima ◽

Yasufumi Yada ◽

Yosimasa Hayase

Keyword(s):

Urinary Tract ◽

Interstitial Cystitis ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

Bladder Capacity ◽

Elderly Male ◽

Urinary Tract Symptoms ◽

Male Patients ◽

Lower Urinary

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Comprehension and construct validity of the Visual Prostate Symptom Score by men with obstructive lower urinary tract symptoms in rural Africa

Canadian Urological Association Journal ◽

10.5489/cuaj.4589 ◽

2017 ◽

Vol 11 (11) ◽

pp. E405-8 ◽

Cited By ~ 2

Author(s):

Lynn Stothers ◽

Andrew Macnab ◽

Francis Bajunirwe ◽

Sharif Mutabazi ◽

Catherine Lobatt

Keyword(s):

Urinary Tract ◽

Symptom Score ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

Formal Education ◽

Image Size ◽

Urinary Tract Symptoms ◽

Student’S T ◽

The Individual ◽

Lower Urinary

Introduction: The Visual Prostate Symptom Score (VPSS) is an image-based interpretation of the International Prostate Symptom Score (IPSS) intended to quantify frequency, nocturia, weak stream, and quality of life (QoL) in a literacy-independent manner.Methods: Ugandan men presenting with lower urinary tract symptoms (LUTS) to a rural clinic completed VPSS and IPSS independently and then with assistance. They verbally interpreted VPSS images, rated question usefulness, and suggested improvements. Responses between word-based and image-based measures were compared (Student’s T, Fisher’s exact, and Spearman’s correlation tests).Results: 132 scores from 33 men (mean age: 61 years, range 28‒93; education: no schooling 20%, grades 1‒4 62%, 5‒7 9%, 8‒12 9%). Correlation between IPSS and VPSS scores was positive (r= 0.70), as it was between the individual irritative, obstructive, and QoL questions. Independent of education, the weak stream image was best recognized. Likert scale measures indicated this was the most useful image, followed by daytime frequency. Nocturia and QoL images were rated as less clear, with explanation required before most understood that QoL facial expression images reflected overall LUTS impact. Improvements suggested included: increased image size for frequency and nocturia pictograms, increased black/white contrast for nocturia, and addition of an image to allow reporting of urgency.Conclusions: In a population with little formal education, there was positive correlation between IPSS and VPSS, with inherent recognition best for weak stream and worst for QoL images. Increased image clarity and an additional image for urgency will enhance the global utility of the VPSS for men to report symptoms of LUTS.

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