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

Objective: Urinary retention is a common postoperative problem. We aimed to investigate the incidence of postoperative urinary retention (POUR) in surgical population and identify the perioperative risk factors for POUR. Materials and Methods: A total of 332 patients, who underwent elective surgery between May 2012 and July 2012, were included in this prospective observational study. Patients under 18 years of age and those with a history of renal failure or benign prostate obstruction were excluded from the study. Group 1 was consisted of patients who had not developed POUR, whereas patients who experienced POUR were included in group 2. Demographic variables and risk factors related with POUR were compared between the two groups. Results: Of the 332 patients enrolled in the study, 179 (53.9%) were men and 153 (46.1%) were women. Thirty-three (9.9%) patients developed urinary retention. Comparison of demographic and perioperative variables between the two groups revealed that Diabetes Mellitus (DM) and spinal anesthesia were significantly associated with POUR (p=0.039 and p=0.043, respectively). Multivariate logistic regression analysis found that DM [p=0.017, odds ratio (OR): 3.009; 95% confidence interval (CI), 1.221– 7.414] and spinal anesthesia (p=0.031, OR: 2.266; 95% CI, 1.079-4.760) were significant independent risk factors for developing POUR. Conclusion: DM and spinal anesthesia were found to be risk factors for POUR. Awareness of risk factor for POUR during preoperative anesthesiology evaluation may help identify patients at risk for POUR, who could benefit from interventions, and prevent POUR and its potential complications.

Cerrahi Popülasyonda Postoperatif Üriner Retansiyon Risk Faktörleri: Prospektif Kohort Çalışması

Amaç: Üriner retansiyon sık görülen bir postoperatif problemdir. Bu çalışmada cerrahi popülasyondaki postoperatif üriner retansiyon (POUR) insidansını ve gelişiminde rol oynayan perioperatif risk faktörlerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Mayıs ve Temmuz 2012 tarihleri arasında elektif cerrahi geçiren 332 hasta bu prospektif kohort çalışmasına dahil edildi. On sekiz yaşından genç hastalar, renal yetmezlik ve benign prostat obstrüksiyonu olan hastalar çalışma dışı bırakıldı. POUR gözlenmeyen hastalar grup 1, POUR gözlenen hastalar ise grup 2 olarak değerlendirildi. Gruplar demografik değişkenler ve POUR gelişimi için risk faktörü kabul edilen değişkenler açısından karşılaştırıldı. Bulgular: Çalışmaya dahil olan 332 hastanın 179’u (%53,9) erkek; 153’ü (%46,1) ise kadın idi. Otuz üç (%9,9) hastada POUR gelişti. Gruplar demografik değişkenler ve POUR gelişimi için risk faktörleri açısından karşılaştırıldığında Diyabetes Mellitus (DM) ve spinal anestezi POUR gelişimi için anlamlı risk faktörleri olarak bulundu (p=0,039, p=0,043, sırasıyla). Çok değişkenli lojistik regresyon analizi sonucunda ise DM [p=0,017, odds ratio (OR): 3,009; 95% confidence interval (CI), 1.221-7.414] ve spinal anestezi (p=0,031, OR: 2,266; 95% CI, 1,079-4.760) POUR gelişimi için anlamlı bağımsız risk faktörleri olarak saptandı. Sonuç: DM ve spinal anestezi postoperatif üriner retansiyon gelişimi için risk faktörleri olarak tespit edildi. Preoperatif anestezi değerlendirilmesinde POUR risk faktörlerinin farkında olunması POUR riski taşıyan hastaların belirlenmesi ve bunu önleyecek girişimlerde bulunulması üriner retansiyonun olası potansiyel komplikasyonların önlenmesi açısından önem arz eder.

Kaynakça

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009;110:1139- 1157.

Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 2005;101:592-596.

Lamonerie L, Marret E, Deleuze A, Lembert N, Dupont M, Bonnet F. Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement. Br J Anaesth 2004;92:544-546.

Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with ultrasound scanner. Acta Anaesthesiol Scand 2002;46:279- 282.

Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after shortacting spinal epidural anesthesia. Anesthesiology 2002;97:315-319.

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative Urinary Retention: Anesthetic and Perioperative Considerations. Anesthesiology 2009;110:1139- 1157.

Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, Tanaka Y, Suzuki K, Masuda J, Tanaka M. Postoperative urinary retention after surgery for benign anorectal disease: Potential risk factors and strategy forprevention. Int J Colorectal Dis 2006;21:676-682.

Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 2002;97:315-319.

Petersen MS, Collins DN, Selakovich WG, Finkbeiner AE. Postoperative urinary retention associated with total hip and total knee arthroplasties. Clin Orthop Relat Res 1991;269:102-108.

Kuipers PW, Kamphuis ET, van Venrooij GE, van Roy JP, Ionescu TI, Knape JT, Kalkman CJ. Intrathecal opioids and lower urinary tract function: A urodynamic evaluation. Anesthesiology 2004;100:1497-503.

Kebapci N, Yenilmez A, Efe B, Entok E, Demirustu C. Bladder dysfunction in type 2 diabetic patients.Neurourology and Urodynamics 2007;26:814–819.

Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology 1998;88:310-316.

Petros JG, Bradley TM. Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 1990;159:374-376.

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