Risk and Management of Postoperative Urinary Retention Following Spinal Surgery

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.

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Postoperative urinary retention in patients undergoing elective spinal surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.8.spine151371 ◽

2017 ◽

Vol 26 (2) ◽

pp. 229-234 ◽

Cited By ~ 26

Author(s):

David Altschul ◽

Andrew Kobets ◽

Jonathan Nakhla ◽

Ajit Jada ◽

Rani Nasser ◽

...

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Urinary Retention ◽

Spine Surgery ◽

Spinal Surgery ◽

Cauda Equina Syndrome ◽

Foley Catheter ◽

Cauda Equina ◽

Leg Pain ◽

Postoperative Urinary Retention

OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.

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A Clinical Nurse Specialist–Directed Initiative to Reduce Postoperative Urinary Retention in Spinal Surgery Patients

AJN American Journal of Nursing ◽

10.1097/01.naj.0000490176.22393.69 ◽

2016 ◽

Vol 116 (8) ◽

pp. 47-52 ◽

Cited By ~ 2

Author(s):

Nicole Hoke ◽

Christine Bradway

Keyword(s):

Urinary Retention ◽

Spinal Surgery ◽

Clinical Nurse Specialist ◽

Nurse Specialist ◽

Clinical Nurse ◽

Postoperative Urinary Retention

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Analysis or evaluation of risk factors and predictability of postoperative urinary retention following spinal surgery

The Spine Journal ◽

10.1016/j.spinee.2017.01.008 ◽

2017 ◽

Vol 17 (4) ◽

pp. 478-479 ◽

Cited By ~ 1

Author(s):

Bikash Bose

Keyword(s):

Risk Factors ◽

Urinary Retention ◽

Spinal Surgery ◽

Postoperative Urinary Retention

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Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

Ear Nose & Throat Journal ◽

10.1177/01455613211033112 ◽

2021 ◽

pp. 014556132110331

Author(s):

Yong Won Lee ◽

Bum Sik Kim ◽

Jihyun Chung

Keyword(s):

General Anesthesia ◽

Incidence Rate ◽

Urinary Retention ◽

Nasal Surgery ◽

Prostate Hyperplasia ◽

Postoperative Urinary Retention ◽

Asa Classification ◽

History Of ◽

Male Patients ◽

Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

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