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Background: Postoperative urinary retention (POUR) is a common complication of anorectal surgery. This study was to determine the incidence of POUR in anorectal surgery for benign anorectal diseases, identify its risk factors, and establish a nomogram for prediction of POUR. Methods: A nested case–control study was conducted. The clinical data of patients were collected, and the incidence of POUR was analyzed. Univariate analysis was used to identify the risk factors associated with POUR, and multivariate logistic regression analysis was used to determine independent risk factors for POUR. A nomogram for the preoperative prediction of POUR using a logistic regression model was developed (n = 609). Results: The incidence of POUR after anorectal surgery for benign anorectal diseases was 19.05%. The independent risk factors for POUR were: female (P = 0.007); male with benign prostatic hyperplasia (BPH) (P = 0.001); postoperative visual analogue scale (VAS) score > 6 (P = 0.002); patient-controlled epidural analgesia (PCEA) (P = 0.016); and a surgery time > 30 min (P = 0.039). In the nomogram, BPH is the most important factor affecting the occurrence of POUR, followed by a postoperative VAS score > 6, PCEA, surgery time > 30 min, and sex has the least influence. Conclusion: For patients undergoing anorectal surgery for benign anorectal diseases, preventive measures can be taken to reduce the risk of POUR, taking into account the following risk factors: female or male with BPH, severe postoperative pain, PCEA, and surgery time > 30 min. Furthermore, we developed and validated an easy-to-use nomogram for preoperative prediction of POUR in anorectal surgery for benign anorectal diseases. Trial registration: China Clinical Trial Registry: ChiCTR2000039684, 05/11/2020. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study was aimed at determining the effect of sugammadex versus a combination of glycopyrrolate and neostigmine (GN) for neuromuscular reversal blockage on transient postoperative urinary retention (TPOUR) in patients undergoing a laparoscopic and robot-assisted laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study in patients undergoing a laparoscopic or robotic hysterectomy between February 2017 and December 2021. Patients with and without concomitant procedures were included. Demographics and perioperative data were extracted from the patient's medical record. Before discharge, all patients were required to spontaneously void and have a post-void residual of less than 150 ml. Results: We identified 500 patients and 485 were included in the final analysis. We had 319 subjects who received sugammadex and 166 GN combination. Both groups had overall similar demographics and perioperative characteristics. Most patients had a conventional laparoscopy procedure (391 [82.5%]) compared with robotic (83 [17.5%]). Patients who received GN were significantly more likely to be discharged home with an indwelling catheter (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.09—3.05). After adjusting for perioperative medications and sling implantation during the surgery a logistic regression model continued to demonstrate that patients who received GN had significantly higher odds of being discharged with a catheter (OR, 1.79; 95% CI, 1.03–3.12). Conclusions: Our findings suggest that sugammadex decreases the odds of TPOUR after laparoscopic hysterectomies with and without slings compared with the combination of GN. Additional prospective trials are required to confirm this finding. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine the association between diabetes mellitus and postoperative urinary retention on cerebral angiography (including intravascular interventional therapy). Methods: We collected data on the demographic characteristics and comorbidities, imaging and routine laboratory data, surgical information, and medications of patients who underwent cerebral angiography. Multivariate logistic regression was used to explore the correlation between diabetes and the incidence of postoperative urinary retention. Results: A total of 932 patients were included, with a mean age of 59.7 years (74.1% men). Postoperative urinary retention occurred in 40.8% of the diabetes mellitus group and 30.3% of the group without diabetes. Compared with the group without diabetes, those with diabetes were more likely to experience postoperative urinary retention. Patients with higher glycosylated hemoglobin A1c levels had a higher risk of developing postoperative urinary retention. Conclusions: Diabetes was independently linked to postoperative urinary retention following cerebral angiography and patients with glycosylated hemoglobin A1c levels > 6% were more likely to experience postoperative urinary retention. Therefore, clinically regulating blood glucose levels may help to reduce the likelihood of postoperative urinary retention after cerebral angiography. [ABSTRACT FROM AUTHOR]

This program evaluation aimed to determine if a new touch-free catheter met expectations to reduce urinary tract infections (UTIs) and traumatic catheterizations at a 319-bed hospital on the Florida Gulf Coast. The hospital revised their Bladder Care Bundle policy in September 2020. This document provided an algorithm to determine if intermittent urinary catheterization is warranted rather than an indwelling catheter to relieve urinary retention. Concurrently, this change included the introduction of a new product. This trademarked touch-free hydrophilic intermittent catheter is considerably different from the traditional straight intermittent catheter previously utilized by the hospital. The hospital also requested demographic information be collected identifying the patients who typically require straight catheterization. This evaluation was completed by doing a retrospective chart review to obtain data that compared urinary catheterization outcomes before and after the touch-free hydrophilic intermittent catheter implementation. The data revealed before the introduction of the touch-free hydrophilic catheter, there were two adverse events noted as traumatic insertions and no development of UTIs. In the data analyzed after the adoption of the touch-free hydrophilic catheter, no UTIs or traumatic insertions occurred. In conclusion, ongoing surveillance for the development of UTIs and traumatic insertions after using the touch-free hydrophilic catheter is recommended to assess its impact over a longer period with a larger number of patients. Additionally, it begins to identify the contribution of this type of touch-free catheter being used for acute urinary retention in hospitalized patients. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative urinary retention (POUR) is a complication of surgery defined as the inability to empty a full bladder. POUR can prolong hospital length of stay and increase rates of urinary tract infection in the postoperative period. Risk factors for the development of POUR include male sex, older age, select medications, and certain comorbid conditions. Surgical factors may also increase the risk of POUR. POUR occurs in up to 50% of patients undergoing colorectal surgery. Materials and Methods: This retrospective, single-center cohort study evaluated the incidence of POUR in patients admitted for colorectal surgery and were enrolled in a Colorectal Enhanced Surgical Recovery (CERAS) protocol. Our primary objective was to determine the incidence of POUR in patients treated under the CERAS protocol. Secondary objectives included evaluating the incidence of POUR in patients receiving intrathecal anesthesia. Results: Two hundred and twenty-eight patients were included. Sixty-six patients (28.9%) developed POUR during their hospitalization. Patients who developed POUR were more likely to be male (61.6% vs. 44.4%, P = 0.029) and tended to be older (mean ± standard deviation age, 61.4 ± 17.7 years vs. 56.8 ± 16.4 years; P = 0.069) compared to the non-POUR group. Regional anesthesia did not affect the incidence of POUR. Conclusions: We identified a rate of POUR in our CERAS patients consistent with previous studies. The risk of POUR increased with increasing age, male sex, and history of benign prostatic hyperplasia and diabetes mellitus. We found no difference in POUR incidence with the type of regional anesthesia utilized. [ABSTRACT FROM AUTHOR]

Background: Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient's discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). Methods: We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. Discussion: This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the perioperative characteristics associated with an increased risk of postoperative urinary retention (POUR) following vaginal pelvic floor surgery. Design: A retrospective cohort study using multivariable prediction modelling. Setting: A tertiary referral urogynaecology unit. Population: Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020. Methods: Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the model with the largest concordance index (c‐index) from internal cross‐validation. This was then externally validated using a separate data set (n = 94) from another surgical centre. Main outcome measure: Diagnosis of POUR following surgery while the patient was in hospital. Results: Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Preoperative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage and uroflowmetry parameters. Significant perioperative factors included estimated blood loss, volume of intravenous fluid administered, operative time, length of stay and specific procedures, including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy and colpocleisis. The lasso logistic regression model had the best combination of internally cross‐validated c‐index (0.73, 95% CI 0.71–0.74) and a calibration curve that showed good alignment between observed and predicted risks. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/). Conclusions: This POUR risk calculator will allow physicians to counsel patients preoperatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options. [ABSTRACT FROM AUTHOR]

Introduction and aims: Postoperative urinary retention (POUR) is a complication that often leads to adverse outcomes and prolonged hospital stay if treatment is delayed. The aim of this project was to improve the competence of nurses in the provision of preoperative POUR education and ensure all patients received preoperative POUR education, and hence reduce the incidence of POUR. Methods: The evidence-based quality improvement project utilized JBI's Practical Application of Clinical Evidence System and Getting Research into Practice module, adopting two POUR best practice recommendations and two audit criteria. The first criterion was for nurses to conduct preoperative education on POUR and the second criterion was to initiate early ambulation of postoperative patients. The project was implemented in three phases from June 2019 to August 2020 in short-stayer and day surgery wards. Results: Criteria 1 and 2 revealed low compliance of 0 and 30%, respectively, during preimplementation audit. There were significant improvements in the first and second cycles of postimplementation audit for both criteria 1 and 2. Our results indicated that most of the patients who were ambulated early were able to void urine. However, there were a few incidents of urinary retention reported despite early ambulation. Following the audit of the third cycle of postimplementation, the compliance for both criteria were found to be satisfactory (criteria 1: 87%, criteria 2: 82%). Conclusion: The implementation of the evidence-based quality improvement project reduced the incidence of POUR. A standardized management would enable nurses to provide consistency in care and effective management and hence prevent the occurrence of POUR. [ABSTRACT FROM AUTHOR]

Objective: This research was conducted to characterize the prevalence and outcomes of postoperative urinary retention (POUR) after laparoscopic hysterectomy (LH) for definitive surgical management of stages III and IV endometriosis without an explicit nerve-sparing (NS) technique. Materials and Methods: This was a retrospective chart review of 106 cases from a single institution of patients who underwent LH for severe endometriosis without an explicit NS technique between March 2014 and August 2020. Six cases were excluded for concurrent low anterior–bowel resection, laparotomy, or incomplete charting. Results: The primary outcome was persistent POUR, defined in this study as continued need for catherization and self-reported sensation of POUR at ∼6 weeks postoperatively. At this time, 5/100 (5.0%) patients met the criteria for persistent POUR, of which 1/100 (1.0%) had objective evidence of retention requiring further management. Immediate POUR was present in 19/100 (19%) of patients. Only 5/100 (5.0%) required continued catheterization past discharge. No patients required catherization at 6 weeks. Conclusions: In nonexplicit NS LH for severe endometriosis, POUR is transient and rarely requires post-discharge catheterization. This study highlights a need for more investigation comparing conventional and NS techniques for reducing POUR after definitive laparoscopic surgery for advanced-stage endometriosis. (J GYNECOL SURG 38:309) [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Previous studies have found that administration of phenazopyridine decreased short-term urinary retention following surgery but other more recent trials have shown mixed results. This study sought to investigate the potential benefit of preoperative administration of oral phenazopyridine in relation to the prevention of short-term urinary retention following urogynecologic surgery. Methods: This is a retrospective cohort study of a convenience sample of women undergoing urogynecologic surgery from June 2016 to March 2019. Following surgery, subjects underwent a standardized retrograde voiding trial. The data had previously been gathered from a prior prospective trial at our institution (Kesty et al. Int Urogynecol J 31(9):1899–1905, 11). Chart review was performed to determine whether patients that received 200 mg of preoperative oral phenazopyridine to better visualize ureteral efflux during cystourethroscopy were more or less likely to pass their postoperative voiding trial. Bivariate statistical analysis was performed as well as a multivariate logistic regression model. Results: A total of 165 subjects were included in the final analysis; 100 who did not receive preoperative phenazopyridine and 65 who did receive phenazopyridine. There was no statistical difference between voiding trial pass rates following urogynecologic surgery between those who did not receive preoperative phenazopyridine compared to those who did [77% (77/100) and 82% (53/65), respectively, p = 0.37)]. The multivariate logistic regression model demonstrated no difference in postoperative voiding trial pass rates among those who received preoperative phenazopyridine compared to those who did not (OR 1.7, 95% CI: 0.53, 5.8). Conclusions: Preoperative administration of oral phenazopyridine does not decrease short-term urinary retention following urogynecologic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To determine predictors for postoperative urinary retention in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. Postoperative urinary retention affects almost every third adolescent after spinal fusion for idiopathic scoliosis. There are limited data regarding the risk factors of postoperative urinary retention in this patient group. Methods: A retrospective study with prospectively collected urinary retention data from paediatric spine register with 159 consecutive patients (114 females, mean age 15.6 years, range 10–21 years) undergoing pedicle screw instrumentation for adolescent idiopathic scoliosis at a university hospital between May 2010 and April 2020. Postoperative urinary retention was defined as an inability to void after catheter removal and documented residual over 300 mL as confirmed using an ultrasound or by catheterization. Results: Postoperative urinary retention was diagnosed in 33% (53 of 159) of the patients during hospital stay. Opioid amount on the day of catheter removal (OR 6.74 [95% CI: 2.47, 18.36], p < 0.001), male gender (OR 2.26 [95% CI: 1.01, 5.05], p = 0.048), and increasing weight (OR 1.04 [95% CI: 1.01, 1.07], p = 0.014) were associated with postoperative urinary retention. Mean opioid consumption on the day of catheter removal was 0.81 mg/kg (95% CI: 0.66, 0.96) in the retention group vs 0.57 mg/kg (95% CI: 0.51, 0.64) in the non-retention group, p < 0.001. Conclusions: Higher total opioid consumption, opioid amount on the day of catheter removal, higher weight, and male gender increases the risk of postoperative urinary retention in adolescents with idiopathic scoliosis undergoing posterior spinal fusion. [ABSTRACT FROM AUTHOR]

Background Context: Limited studies have investigated risk factors for postoperative urinary retention (POUR) following elective spine surgery. Furthermore, some discrepancies have been found in the results of existing observational studies.Purpose: This study aimed to review the available literature on risk factors associated with POUR following elective spine surgery.Study Design: A systematic review with meta-analysis was performed.Patient Sample: A total of 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis.Outcome Measures: Demographics, type of elective spine surgery, country, definition of POUR, and potential risk factors for POUR were evaluated.Methods: The Cochrane Library, Embase, and Medline electronic databases were searched to identify relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean differences (WMD) or standardized mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes.Results: Eleven studies (2 prospective and 9 retrospective) were included in the analysis. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50-9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04-1.64). The following variables were also identified as significant risk factors for POUR: benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89-7.62), diabetes mellitus (DM; OR, 1.50; 95% CI, 1.17-1.93), and previous urinary tract infection (UTI; OR, 1.70; 95% CI, 1.28-2.24). Moreover, longer operative time (WMD, 19.88; 95% CI, 5.01-34.75) and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23-0.52) were observed in patients with POUR. In contrast, spine surgical procedures involving fewer levels (OR, 0.75; 95% CI, 0.65-0.86), and ambulation on the same day as surgery (OR, 0.65; 95% CI, 0.52-0.81) were associated with a decreased risk of POUR.Conclusions: Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI are risk factors for POUR following elective spine surgery. We also found that longer operative time and increased intravenous fluid support would increase the risk of POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative voiding. [ABSTRACT FROM AUTHOR]

Purpose: The rate of postoperative urinary retention (POUR) in laparoscopic inguinal hernia repairs is 1–22%. POUR may cause patient anxiety, discomfort, and increased hospital costs. Currently there is no standard prophylaxis for POUR. Preoperative administration of tamsulosin has been shown to decrease POUR rates in urologic studies. This study aims to evaluate the efficacy of tamsulosin on the incidence of POUR in patients undergoing totally extraperitoneal (TEP) LIHR. Methods: A randomized, double-blinded, placebo-controlled trial was initiated and accrued patients from 2017 to 2019. A total of 169 males undergoing elective TEP LIHR were included. Patients were administered tamsulosin 2 h before surgery and followed for up to 24 h postoperatively for episodes of POUR. Analysis was performed to quantify the association between patient, surgical, and perioperative factors with POUR. Results: The overall rate of POUR was 9%. There was no difference in the rate of POUR between the placebo (9.9%) and tamsulosin groups (7.9%) (p = 0.433). Univariate analysis showed a trend toward POUR in patients with history of benign prostatic hypertrophy (BPH) (p = 0.058). Previously reported risk factors of older age, total IVF, length of procedure and opioid use were not associated with increased rates of POUR. Tamsulosin reduced the time to discharge by 4 to 68 min when compared to placebo. Conclusions: This study suggests that preoperative administration of tamsulosin may not reduce the risk of POUR in males undergoing elective TEP LIHR. Further study with a larger sample size may be needed to show a statistically significant difference. [ABSTRACT FROM AUTHOR]

Perioperative neuromuscular blocking agents are pharmacologically reversed to minimize complications associated with residual neuromuscular block. Neuromuscular block reversal with anticholinesterases (e.g., neostigmine) require coadministration of an anticholinergic agent (e.g., glycopyrrolate) to mitigate muscarinic activity; however, sugammadex, devoid of cholinergic activity, does not require anticholinergic coadministration. Single-institution studies have found decreased incidence of post-operative urinary retention associated with sugammadex reversal. This study used a multicenter database to better understand the association between neuromuscular block reversal technique and post-operative urinary retention. Retrospective cohort study utilizing large healthcare database. Non-profit, non-governmental and community and teaching hospitals and health systems from rural and urban areas. 61,898 matched adult inpatients and 95,500 matched adult outpatients. Neuromuscular block reversal with sugammadex or neostigmine plus glycopyrrolate. Incidence of post-operative urinary retention by neuromuscular block reversal agent and the independent association of neuromuscular block reversal technique and risk of post-operative urinary retention. The incidence of post-operative urinary retention was 2-fold greater among neostigmine with glycopyrrolate compared to sugammadex patients (5.0% vs 2.4% inpatients; 0.9% vs 0.4% outpatients; both p < 0.0001). Multivariable logistic regression identified reversal with neostigmine to be independently associated with greater risk of post-operative urinary retention (inpatients: odds ratio, 2.20; 95% confidence interval, 2.00 to 2.41; p < 0.001; outpatients: odds ratio, 2.57; 95% confidence interval, 2.13 to 3.10; p < 0.001). Post-operative urinary retention-related visits within 2 days following discharge were five-fold higher among those reversed with neostigmine than sugammadex among inpatients (0.05% vs. 0.01%, respectively; p = 0.018) and outpatients (0.5% vs. 0.1%; p < 0.0001). Though this study suggests that neuromuscular block reversal with neostigmine can increase post-operative urinary retention risk, additional studies are needed to fully understand the association. • POUR can increase the clinical and economic burden among surgical patients. • Choice of neuromuscular block reversal agent can impact POUR risk. • This retrospective cohort analysis evaluated POUR risk with NMB reversal technique. • POUR incidence was 2-fold greater with neostigmine with glycopyrrolate vs sugammadex. • NMB reversal without an anticholinergic (e.g., glycopyrrolate) decreases POUR risk. [ABSTRACT FROM AUTHOR]

Purpose: Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively.Methods: We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to "pass" the protocol.Results: Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6-2.9) and 2.3 (95% CI 1.8-3.1) times more likely to have elevated PVR after their second TOV and third TOV (p < 0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA > 2 and placement of MUS were associated with increasing number of voids needed to pass protocol.Conclusions: While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Risk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery. Methods: A case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial. Cases had an acute encounter for urinary retention. Controls did not have acute postoperative urinary retention. Cases and controls were stratified based on procedure. Demographics, medical/surgical histories, voiding symptoms, urodynamic testing, and intraoperative data were collected. Cases were matched to controls in a 1:3 ratio. Mann-Whitney U and chi-square tests were used for univariate analyses; logistic regression was used to determine predictors of delayed postoperative urinary retention (DPOUR). Results: A total of 1219 patients underwent pelvic reconstructive surgery that met eligibility; 51 cases of DPOUR (4.3%) were identified and matched with 153 controls without postoperative urinary retention. Of the procedures performed, 41.2% had prolapse surgery, 10.3% had incontinence surgery, and 48.5% had both prolapse and incontinence surgery. There were no differences between cases and controls in age, race, prior surgery, medical comorbidities, prolapse stage ≥ 3, voiding symptoms, and surgical characteristics. Cases had a lower BMI than controls (p < 0.001). There was no difference in preoperative urodynamic variables. Cases had lower percent voided volume on their last voiding trial than controls (90.2% ± 28.6% vs. 110.7% ± 39.5%, respectively; p = 0.001); however, clinically we consider a voided volume of two-thirds or greater of the instilled volume to be a normal result. Conclusions: DPOUR is an uncommon postoperative event. Demographic and clinical factors and urodynamic findings were unable to predict DPOUR. Percent voided volume on voiding trial was greater in controls. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Mitigating common complications such as postoperative urinary retention (POUR) following elective spine surgery is prudent. Identifying patients at risk for POUR and recognizing associated factors, to avoid a more complicated postoperative episode should be a priority and easily achievable. Understanding the financial burden of complications, such as POUR, is also important for value-based healthcare, not only for providers, but for employers and payors as well.Purpose: The purpose of this study is to examine patient and surgical factors that may lead to increased risk for POUR and its associated cost following elective lumbar laminectomies.Study Design/setting: This is a retrospective study of the incidence of postoperative urinary retention after elective one- and two-level primary lumbar laminectomies.Patient Sample: We followed patients undergoing one- and two-level primary elective lumbar laminectomies performed between April 2014 and December 2016.Outcome Measures: Patient factors included age, gender, body-mass index, and comorbidities. Surgical factors included surgical time, intraoperative fluid volume requirements, anesthesia type, and surgical levels involved. Other outcome variables included length of stay, discharge disposition, 30-day all-cause readmissions and emergency department visits, 90-day complications, and variable direct costs.Methods: The incidence of POUR was evaluated and compared with patient and surgical factors and cost-specific variables to identify correlations and potential risk for POUR after one- and two-level primary lumbar laminectomies.Results: Analysis included 333 patients - 203 one-level laminectomies and 130 two-level laminectomies. The overall incidence of POUR was 17.4%. Age, male gender, and history of urinary retention were significantly associated with POUR. There was a significantly increased risk of POUR with increased surgical time, but not with anesthesia type. There were also no significant differences in body-mass index, other study comorbidities, intraoperative fluid requirements, readmission, emergency department visit, and complication rates between groups. On average, patients with POUR had a significantly longer length of stay than patients without POUR. In addition, more POUR patients were discharged to acute rehabilitation facilities and had higher average variable direct cost compared tonon-POUR patients.Conclusions: POUR is a significant risk after elective laminectomy. This study supports several widely accepted beliefs regarding POUR risk, while challenging others. It also highlights the burden of POUR development after surgery. At our institution, we developed a protocol supported by these findings. [ABSTRACT FROM AUTHOR]

We hypothesized that spinal anesthesia could lead to impairment in bladder function and consequently, to postoperative urinary retention (POUR), particularly in patients undergoing urogynecologic surgery. This study was aimed to compare the rate of the POUR between the subjects receiving spinal and general anesthesia who underwent urogynecologic surgery. One hundred and eighty subjects who underwent urogynecologic surgery between June 2016 and May 2019 were retrospectively analyzed to evaluate the risk of POUR after general versus spinal anesthesia. All subjects underwent a standardized voiding trial subsequent to surgery, which was performed by backfilling the bladder with 300 ml of saline. The presence of > 100 ml volume in the post-void bladder scan was defined as POUR. The primary outcome was to compare rates of POUR between spinal and general anesthesia. Identifying the risk factors for POUR was the secondary outcome of this study. Spinal anesthesia group included 80, and the general anesthesia group consisted of 100 patients. The overall rate of the POUR was %22.8. The proportion of the patients with POUR was significantly higher in the spinal anesthesia group compared to that of the subjects in the general anesthesia group (%33.8vs%14, P=0.002). Multivariate logistic regression analysis revealed that the adoption of spinal anesthesia (Odds ratio: 3.172, 95%CI: 1.383-7.275, P=0.006) and presence of diabetes (Odds ratio: 5.840, 95% CI:2.325- 14.666, P< 0.001) were independent predictors for the development of POUR. The rate of the POUR is significantly higher in patients receiving spinal anesthesia than those receiving general anesthesia among women undergoing urogynecologic surgery. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Spinal anesthesia can be a potential risk factor for postoperative urinary retention (POUR). Our objective was to compare POUR rates for outpatient vaginal pelvic floor surgeries when using spinal versus general anesthesia. Our hypothesis was that spinal anesthesia would have higher POUR rates compared with general anesthesia. Methods: This was a randomized clinical trial on subjects undergoing outpatient pelvic organ prolapse (POP) surgery with a concomitant midurethral sling (MUS). Subjects were discharged home the same day as surgery. Subjects were excluded if they had a preoperative post-void residual > 150 ml, they were < 40 years of age, surgery was < 1 h, or they had contraindications to spinal or general anesthesia. A standardized voiding trial was performed. The primary aim was to compare POUR rates between anesthesia groups. A power analysis estimated 28 subjects were required per group to detect a 37% difference with 80% power and an alpha of 0.05. Results: The trial was registered at ClinicalTrials.gov on July 15, 2015. Sixty-one subjects were enrolled between June 22, 2015, and December 31, 2017. Three were excluded, leaving 29 in each group. Groups were similar in demographics. For the primary outcome, there was a 14.3% difference in POUR rates between spinal and general anesthesia, which did not reach statistical significance based on our power calculation (p = 0.2516). Conclusions: Based on this study, there is not an increased rate of POUR with the use of spinal anesthesia for POP surgery with MUS. However, since there was a trend toward higher rates of POUR in the spinal group, it is possible that a larger powered study design would be able to detect a statistically significant difference between the groups. Based on these findings, if surgical patients would benefit from spinal anesthesia, the risk of urinary retention should not be considered a reason to not utilize this form of anesthesia. Clinical trial registration: Does spinal anesthesia for prolapse surgery with concomitant sling lead to an increase in urinary retention compared to general anesthesia? https://clinicaltrials.gov/ct2/show/NCT02547155?term=laura+martin&rank=3 (NCT02547155) [ABSTRACT FROM AUTHOR]

Background and Aims: Following spinal anesthesia (SA), patient discharge is often delayed due to postoperative urinary retention (POUR), the incidence of which varies widely. The present study of bupivacaine versus ropivacaine in equianalgesic doses was taken to explore the correlation between time to void urine and time for complete functional recovery. Material and Methods: In this double-blinded study fifty adult patients were assigned to two groups (bupivacaine/ropivacaine) according to alternate case allocation for receiving SA for lower abdominal, perineal, and lower limb surgeries, lasting less than 2 h. Statistical analysis was conducted using an intention-to-treat approach, using Mann–Whitney test for nonparametric data. Primary outcome data could not be obtained for 14 out of the 50 patients due to perioperative bladder catheterization. No patients were lost to follow-up. Results: Both the bupivacaine and ropivacaine groups were comparable in terms of ability to void (8.0 ± 2.3 vs. 7.0 ± 1.2 h;P > 0.05), modified Bromage scale after 4 h of SA (1.8 ± 1.3 vs. 2.6 ± 0.9 grade;P > 0.05), time to complete ambulation (6.7 ± 1.4 vs. 6.1 ± 1.0 h;P > 0.05), and time to negative Romberg test (6.1 ± 1.4 vs. 5.6 ± 0.9 h;P > 0.05), respectively. Strong positive correlations (r = 0.7–0.9) were found between time to void urine and time for complete ambulation. Conclusions: Time to void urine and recovery of motor functions were found comparable statistically when bupivacaine and ropivacaine were used in the doses of 12.5 and 18.75 mg, respectively, for SA. However, group ropivacaine required lesser time to void and no patient developed POUR. Time to void urine was more than the time for ambulation. This may indicate a need for "selective spinal anesthesia" or adjuvant combination technique to accelerate the resolution of a block for ambulatory surgery. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: There is a distinct lack of literature on postoperative management after anterior colporrhaphy (AC). Our traditional postoperative protocol consisted of 24 h of indwelling catheterisation followed by 24 h of self-intermittent catheterisation. We hypothesised that a new protocol consisting of only 24 h of indwelling catheterisation might produce better results without additional complications. Methods: From April 2014 to July 2017, all candidates for AC were randomised to catheter removal 24 or 48 h after surgery. The primary outcome was the postoperative urinary retention (POUR) rate. Secondary outcomes included: asymptomatic bacteriuria (AB), urinary tract infection (UTI) and postoperative pain after 24 h. Results: A total of 79 patients were recruited. Thirty-seven and 40 patients were randomised to follow the 48-h protocol and the 24-h protocol respectively. There were no significant differences in relation to the POUR rate: 3 patients (8.1%) vs 1 (2.5%) in the 48-h vs the 24-h group respectively (p = 0.346). The UTI rate was 2 (8.1%) vs 0 patients respectively (p = 0.139) and the postoperative AB rate was 3 (9.1%) vs 0 patients (p = 0.106). In the postoperative pain evaluation, the visual analogue scale score was significantly higher in the 48 h group (0.35 vs 0.13, p = 0.02). Conclusions: According to our results, reducing the catheterisation from 48 to 24 h after AC does not increase the risk of POUR and decreases the rate of UTI, AB and postoperative pain. This new postoperative management protocol of pelvic floor surgery would improve postoperative outcomes and shorten the stay in hospital. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative urinary retention is a common adverse effect after rectal surgery. Current methods for assessing postoperative urinary retention (residual urine volume) are inaccurate and unable to predict long-term retention. Voiding efficiency is an effective indicator of postoperative urinary retention in urological and gynaecological fields, but not in colorectal surgery. We aimed to determine whether voiding efficiency in the initial 24 h after urinary catheter removal was more effective in predicting the incidence of postoperative urinary retention than residual urine volume. Methods: In this retrospective, observational study using prospectively collected data from patients who visited the colorectal department of a single institution, 549 patients who underwent rectal cancer surgery between April 2012 and May 2016 were initially enrolled, of which 46 were excluded and 503 finally included. Results: The incidence of postoperative urinary retention was 18.5% (93/503). Multivariable logistic regression analyses revealed that the association of postoperative urinary retention with voiding efficiency < 50% was stronger than that with residual urine volume > 100 mL (odds ratio, 38.30 (residual urine volume) and 138.0 (voiding efficiency)). Voiding efficiency was significantly lower in patients with long-term than in those with short-term postoperative urinary retention (adjusted p value = 0.02), whereas residual urine volume was not different between the two groups. Multivariable logistic regression analysis for long-term postoperative urinary retention showed the strongest association with voiding efficiency < 20% (odds ratio, 25.70). Conclusions: Voiding efficiency is a more effective predictor of postoperative urinary retention than residual urine volume in rectal cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the risk factors for postoperative urinary retention (POUR) among female patients by evaluating its occurrence in women who underwent laparoscopic cholecystectomy in Gyeongsang National University Hospital. Methods: The medical records of female patients who had undergone laparoscopic cholecystectomy for gallbladder stones between March 2014 and February 2018 were reviewed. Information was collected regarding patient age, body mass index (BMI), creatinine, absolute neutrophil count, duration of the operation and anesthesia, the amount of fluid infused, American Society of Anesthesiologists (ASA) classification, and medical comorbidities, such as hypertension, diabetes, and lung, liver, heart, renal, and neurologic disease. Comparisons were made between the POUR and non‐POUR groups, and both univariate and multivariate analyses were conducted. Results: Seventeen of 591 patients (2.9%) developed POUR. There as a positive correlation between age and POUR (P = 0.040), and a negative correlation between BMI and POUR (P = 0.037). In addition, a history of neurologic disease was greater in the POUR group (P = 0.033), which also had a higher ASA class than the non‐POUR group (P < 0.001). Multivariate analysis showed that a high ASA class was a risk factor for POUR (hazard ratio 3.01; 95% confidence interval 1.13‐7.99; P = 0.027). Conclusions: Medical care providers need to be aware of the risk factors for POUR, which is likely to prolong hospital stay for Foley catheter placement. A high ASA class is an important risk factor for POUR among female patients, so medical staff need to provide proper preoperative management strategies for patients with a high ASA class. [ABSTRACT FROM AUTHOR]

>bold<>italic/italic<>/bold< Postoperative urinary retention (POUR) is one of the most frequent complications of epidural anesthesia. This study aims to clarify risk factors of POUR and to estimate the appropriate timing of urethral catheter removal. >bold<>italic/italic<>/bold< Between September and December 2014, a retrospective cohort study was conducted on 120 patients who underwent epidural anesthesia and major abdominal surgery. To observe trends in incidence of POUR, we analyzed the order and interval of removal of epidural and urethral catheters using Cochran-Armitage trend test. >bold<>italic/italic<>/bold< In this study, 40 patients were diagnosed with POUR (33.3%). Median removal of epidural catheters was 4 postoperative days in the POUR group and 3.5 postoperative days in the non-POUR group (>italic/italic< = 0.04). When the urethral catheter was removed before epidural catheter, incidence of POUR was comparatively greater (>italic/italic< < 0.001). There were no statistical differences in surgical fields, operation approach, epidural catheter levels, or epidural opioid use. No patients had urinary tract infections. >bold<>italic/italic<>/bold< We demonstrated that removal of urethral catheter before epidural catheter contributed to increasing trends in incidence of POUR. The optimal order and interval of removal of epidural and urethral catheters should be considered to avoid POUR after abdominal surgery. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair.Methods: Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression.Results: PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit.Conclusions: PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative urinary retention (POUR) is one of the most common complications following spinal anesthesia. Spinal anesthesia may influence urinary bladder function due to interruption of the micturition reflex. Urinary catheterization is the standard treatment of POUR. Urinary catheter insertion is an invasive procedure, which is associated with catheter-related infections, urethral trauma, and patient discomfort. The purpose of this study was to determine the effectiveness of intramuscular (IM) neostigmine to accelerate bladder emptying after spinal anesthesia.Patients and Methods: A total of 36 patients undergoing lower abdominal (except for pelvic, urologic, anorectal, and hernia surgery) and lower extremity surgery under spinal anesthesia were divided into two groups randomly (n=18), to either neostigmine (N) group or control (C) group. Neostigmine 0.5 mg (N group) or NaCl 0.9% (C group) was administered intramuscularly when Bromage score 0 and sensory level sacral two have been achieved. The time to first voiding after IM injection and the time to first voiding after spinal anesthesia were measured.Results: The time to first voiding after IM injection was significantly faster (P≤0.05) in the N group than that in the C group, with median time as 40 minutes (20-70 minutes) and 75 minutes (55-135 minutes), respectively. Time to first voiding after spinal anesthesia was also significantly faster (P≤0.05) in the N group than that in the C group (mean of 280.8±66.6 minutes and 364.2±77.3 minutes, respectively).Conclusion: IM neostigmine effectively accelerates bladder emptying after spinal anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after surgery, is a commonly reported complication. This study reports the incidence and possible risk factors for POUR after elective fast-track hip or knee arthroplasty when using a nurse-led bladder scan protocol. Methods: This retrospective cohort study included data from 803 patients who underwent unilateral hip or knee arthroplasty. Patients' digital clinical records were reviewed for eligibility. Patients with incomplete data registration, preoperative bladder volume >250 ml, preexisting bladder catheterization, and/or patients following the outpatient pathway were excluded. Bladder volumes were assessed at different moments pre- and postoperatively. The outcome was the incidence of POUR, defined as the inability to void spontaneously with a bladder volume >600 ml, treated with indwelling catheterization. Further analysis between POUR and non-POUR patients was performed to detect possible risk factors for POUR. Results: Six hundred and thirty-eight patients operated on primary unilateral hip or knee arthroplasty were analyzed. The incidence of POUR was 12.9% ( n = 82, 95% CI 9.4-15.5). Gender, age, BMI, ASA classification, preoperative bladder volume, type of anesthesia, type of arthroplasty, and perioperative fluid administration were not significant different between POUR and non-POUR patients. Patients with a bladder volume of >200 ml at the recovery room were at higher risk (OR 5.049, 95% CI 2.815-9.054) for POUR. Conclusions: When using a nurse-led bladder scan protocol in fast-track hip and knee arthroplasty, the incidence of POUR was 12.9%, with a bladder volume of >200 ml at the recovery room as a risk factor for POUR. Level of evidence: A retrospective cohort study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernia repair is a common general surgery procedure with low morbidity. However, postoperative urinary retention (PUR) occurs in up to 22% of patients, resulting in further extraneous treatments.This single institution series investigates whether patient comorbidities, surgical approaches, and anesthesia methods are associated with developing PUR after inguinal hernia repairs.Methods: This is a single institution retrospective review of inguinal hernia from 2012 to 2015. PUR was defined as patients without a postoperative urinary catheter who subsequently required bladder decompression due to an inability to void. Univariate and multivariate logistic regressions were performed to quantify the associations between patient, surgical, and anesthetic factors with PUR. Stratification analysis was conducted at age of 50 years.Results: 445 patients were included (42.9% laparoscopic and 57.1% open). Overall rate of PUR was 11.2% (12% laparoscopic, 10.6% open, and p = 0.64). In univariate analysis, PUR was significantly associated with patient age >50 and history of benign prostatic hyperplasia (BPH). Risk stratification for age >50 revealed in this cohort a 2.49 times increased PUR risk with lack of intraoperative bladder decompression (p = 0.013).Conclusions: At our institution, we found that patient age, history of BPH, and bilateral repair were associated with PUR after inguinal hernia repair. No association was found with PUR and laparoscopic vs open approach. Older males may be at higher risk without intraoperative bladder decompression, and therefore, catheter placement should be considered in this population, regardless of surgical approach. [ABSTRACT FROM AUTHOR]

Background: Urinary retention is a frequently observed as a postoperative complication that may lead to bladder damage, chronic nephropathy, urinary system infection and sepsis. Such complications can increase patient length-of-stay in a hospital and decrease quality of life. Aims: This study aimed at evaluating the effect of nursing interventions on prevention and management of Postoperative Urinary Retention (PUR) for patients that undergo orthopaedic surgery under spinal anaesthesia. Methodology: This study is a randomised controlled clinical experimental study. This study was implemented at the orthopedics and traumatology clinic of a public hospital in Kocaeli between September 2013 and June 2014 with 132 patients fulfilling the research criteria and 66 patients each in the control and the intervention groups. Data were collected by using “Postoperative Urinary Retention Risk Factors Evaluation Form – I and II”, “Postoperative Retention Management Protocol for Control and Intervention Groups” and a “Portable Bladder Ultrasound Device”. Nursing interventions were performed in accordance with the “postoperative urinary retention management protocol” in intervention group, on the contrary patients in the control group were observed by the researcher without performing any nursing interventions. Results: This work found that PUR is developed in almost all of the patients in the control group. Catheterization was not applied to almost all patients from the intervention group. Meanwhile, a catheter was placed for approximately 1/3 of the patients in the control group. Conclusion: Nursing interventions were effective in decreasing PUR incidence and consequently also reduced urinary catheterization incidence. Nursing interventions can be effective in the prevention and management of PUR. The results of this study will contribute to the improvement of patient care provided by nurses. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort analysis.Objective: The aim of the study was to identify medications that may potentially contribute to developing postoperative urinary retention (POUR) after lumbar spinal fusion procedures.Summary Of Background Data: POUR is a concerning event that may occur after routine orthopedic surgery. The relation between intraoperative medications and POUR after lumbar spine surgery has not been well characterized.Methods: A prospectively maintained database of patients who underwent a primary single-level, minimally invasive transforaminal lumbar interbody fusion between 2009 and 2013 was reviewed. POUR was defined as a bladder scan of 300 mL or higher, the postoperative necessity of a straight catheterization, or a urology consult for urinary retention. The use and dose-response of intraoperative medications between patients with and without POUR were compared. Potential risk factors for developing POUR were analyzed using multivariate analysis.Results: A total of 205 patients were included in the study, 17% of whom experienced POUR (n = 34). Administration of phenylephrine and neostigmine was associated with POUR (phenylephrine: 32.3% vs. 13.8%, P = 0.017; neostigmine: 19.5% vs. 6.5%, P = 0.042). Parametric analysis demonstrated an association of increasing dose of neostigmine with POUR (4.66 vs. 4.22 mg, P = 0.023). Similarly, a nonparametric analysis demonstrated an association of increasing doses of both neostigmine and phenylephrine with POUR (neostigmine: 4.25 vs. 3.16 mg, P = 0.02; phenylephrine: 105.88 vs. 40.64 mg, P = 0.008).Conclusion: Approximately 20% of patients may develop POUR after routine lumbar spine surgery. The use of certain intraoperative anesthetics such as phenylephrine and neostigmine is strongly associated with the development of POUR postoperatively. This finding suggests that there may be modifiable anesthetic risk factors to prevent the development of POUR in patients undergoing lumbar spine surgery. Future prospective, controlled studies specifically addressing these findings could lead to improved patient care and decreased healthcare costs.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Urinary retention is a problem, which is seen prevalently after an anesthesia or a surgical intervention. Defining PUR (Postoperative Urinary Retention) becomes a challenging problem due to the lacking of a universal urinary retention definition and the differences between diagnostic criteria. The common point among PUR definitions is being not able to urinate while having a full urinary bladder. Nurses have important responsibilities in sustaining the functions of the patients including the excretion. These responsibilities might be expressed as; determining risky groups, preventing postoperative urinary retention development, early realization and when developed, managing the urinary retention by using appropriate nursing attempts. It is expected from the nurses to do these responsibilities with a systematic approach and providing a care in cooperation with the doctor. This kind of approach is very important in shortening the time the patient spent in the hospital, increasing the comfort/satisfaction of the patients, preventing complications, avoiding unnecessary usage of analgesics and increasing the quality of life. [ABSTRACT FROM AUTHOR]

Postoperative urinary retention (POUR) is the inability to void when the bladder is full after surgery. It is a common complication in postoperative patients, especially in patients undergoing spinal surgery. At our institution, patients who were discharged from the postanesthesia care unit (PACU) to the inpatient surgical unit typically had bladder distention and a bladder volume of more than 450 mL. In an effort to address this situation, an interprofessional group of advanced practice RNs and physicians formed a team, reviewed the existing literature, examined the PACU nursing practice guideline for evaluating and managing POUR, and devised a quality improvement (QI) project to raise the PACU nursing staff's awareness of the potential for POUR among postoperative patients and to develop an updated nursing practice algorithm for the evaluation and management of POUR in spinal surgery patients. A description of the QI process, including the revised algorithm and pre- and postintervention results, is reported here. In the preintervention group (n = 42), 19 indwelling urinary catheterizations were documented in patient records; no use of intermittent catheterization was documented. In the postintervention group (n = 43), seven indwelling urinary catheterizations were documented in patient records; the use of intermittent catheterization was documented in 11. As a result of our intervention, we decreased the number of indwelling urinary catheters inserted in the PACU, and supported the PACU nursing staff in more frequent and appropriate use of intermittent catheterization in patients undergoing spinal surgery. [ABSTRACT FROM AUTHOR]

Background: Transanal endoscopic microsurgery (TEM) for the excision of rectal tumor is mostly performed as an inpatient procedure. The aim of this study was to assess the feasibility and safety of TEM resection as an outpatient procedure in selected patients.Population: All first 178 consecutive patients who underwent resection of a rectal tumor using TEM in our institution from April 2011 to September 2013 were included.Method: Standardized retrospective chart review was performed. Primary outcome was 30-day mortality and morbidity. Secondary outcomes included unplanned admission and readmission rates, operative and pathologic data.Results: Of the 175 patients who underwent only TEM, 80% (140/175) were discharged the same day of surgery. There was no mortality. Morbidity rate was 31.4%. Ninety-one percent of 154 patients planned as outpatients were discharged the same day. The most common reason for unplanned admission was urinary retention (7/14; 50%). Twelve patients discharged the day of the procedure were readmitted at 30 days. Median operative time was 60 min (10-256 min). All lesions were removed with grossly negative margins with 15 positive microscopic margins on final pathology. A total of 124 adenomatous polyps and 37 malignant lesions were excised. Mean tumor diameter after fixation was 5.0 cm (range 0.5-11 cm).Conclusion: Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe in selected patients. The main reason for unplanned admission was urinary retention in our series. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of postoperative urinary retention (POUR) in our surgical patients and review house staff practices in management. Methods: A chart review of patients with POUR, identified through billing codes, was performed. In addition, a house staff survey was conducted to assess whether straight catheterization (SC) or indwelling urinary catheter (IUC) was preferred at different bladder volumes. Results: The incidence of POUR was 2.2% (n = 43). This resulted in eight urology consults, seven discharges with an IUC, and three readmissions. There were significant disparities between the house staff survey results and actual practices. The mean volume for IUC insertion on the house staff survey was 365 cc compared to 739 cc from our patient cohort. Twenty percent of respondents chose to use SC at bladder volumes in excess of 700 cc. Conclusion: Management of POUR remains highly variable. Best practice guidelines are required to standardize our management of this complication. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort analysis of prospectively collected data. Objective. To determine whether an association exists between body mass and surgical outcomes in patients with degenerative scoliosis after long instrumented spinal arthrodesis (≥ 4 discs). Summary of Background Data. Obesity is thought to be associated with increased surgical complications and inferior clinical outcomes in adults. There are no studies analyzing the effect of obesity on surgical outcomes in patients with degenerative scoliosis after long instrumented spinal arthrodesis. Methods. Eighty-four consecutive patients with degenerative scoliosis (69 females and 15 males; mean age, 68.6 ± 8.0 yr) with a minimum follow-up of 2 years were included in this study. Patients were divided into 3 groups according to body mass index (BMI): obese (BMI ≥ 30 kg/m², n = 19), overweight (BMI = 25-29.9 kg/m m², n = 35), and normal weight (BMI < 25 kg/m m², n = 30). Radiographical measures, Oswestry Disability Index, visual analogue scale score, as well as comorbidities and complications were reviewed and analyzed for all patients preoperativelyand at 1 - and 2-year follow-ups. Results. Compared with the normal weight group, no significant differences in surgical methods, comorbidities, complication rates, curve correction, or radiographical measures were found in the obese and overweight groups, except for a greater preoperative lumbar lor-dosis in the overweight group (-40.3° ± 13.8° vs. -26.0° ± 18.9°, P < 0.05). At 2-year follow-up, Oswestry Disability Index and visual analogue scalescores improved significantly in all groups compared with preoperatively (P < 0.01). The changes of Oswestry Disability Index and visual analogue scalescores from preoperatively to final follow-up were similar in the 3 groups (P > 0.05). Conclusion. Obesity did not affect the amount of deformity correction and did not increase comorbidities and postoperative complication rates. Overweight patients had a greater lumbar lordosis before surgery than normal weight patients. Obese and overweight patients benefited from surgery just as much as normal weight patients at 2-year follow-up. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective case series. Objective. The objectives of this study were to (1) determine the rate of postoperative urinary retention (POUR) in a series of patients undergoing lumbar spine surgery, (2) compare length of hospital stay between patients who developed POUR and patients who did not, and (3) identify the patient and surgical factors associated with the development of POUR. Summary of Background Data. Although POUR is a common complication in many surgical subspecialties, sparse literature is present regarding development of POUR after posterior lumbar surgical procedures. Methods. A retrospective review was conducted of all posterior lumbar surgery cases performed at single institute from July 2008 to July 2012. Data collected included demographic variables (age, sex, body mass index), length of stay, comorbid medical conditions, and surgical data. The Wilcoxon rank sum test with continuity correction was used to compare length of hospital stay between patients who developed POUR and patients who did not. A multivariate logistic regression model was created using all patient and surgical factors and systematically pruned of variables not improving overall predictive power. Results. A total of 647 patients (291 decompression, 356 decompression and fusion) were included in the study. Of 647 patients, 36 had urinary retention after lumbar spine surgery (5.6%). Patients who developed POUR had a longer length of stay than patients who did not develop POUR (3.94 d vs. 2.34 d; P = 0.005). Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with development of POUR (odds ratio = 3.05, 9.82, 1.04, 3.32, and 2.51, respectively). Smoking was inversely associated with the development of POUR (odds ratio = 0.45). Conclusion. The risk of developing POUR after posterior lumbar spine surgery is approximately 5%. Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with the POUR group. Patients who developed POUR had a greater length of hospital stay. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of postoperative urinary retention (PUR) has been reported to range from 1% to 22% in patients who have undergone laparoscopic inguinal hernia procedures. The objectives of this study were to determine the incidence of PUR and examine different risk factors that may be associated with the development of PUR in patients who have undergone laparoscopic inguinal hernia procedures. METHODS: A retrospective chart review was performed on 350 patients. Demographics, comorbidities, and operative and postoperative information were collected in patients undergoing laparoscopic inguinal hernia repair by 3 general surgeons from 2007 to 2011. Statistical analysis was done on patient demographics, medical histories, anesthesia notes, and postoperative notes to identify risk factors for the development of urinary retention after laparoscopic inguinal hernia repair RESULTS: Three hundred fifty consecutive patients who underwent laparoscopic inguinal hernia repairs were reviewed. Twenty-nine patients developed PUR, an incidence of 8.3%. Age ≥60 years and history of benign prostatic hyperplasia showed significance on multivariate analysis, with odds ratios of 3.0 and 11.0 respectively (P <.05). Anesthesia time ≥2 hours (odds ratio, .75) was a contributing perioperative risk factor but only as an independent risk factor (P < .05). CONCLUSIONS: History of benign prostatic hyperplasia, age ≥60 years, and anesthesia time ≥2 hours were significant independent risk factors for urinary retention after laparoscopic inguinal hernia repair. On multivariate analysis, only history of group and age ≥60 years showed significance. This is 1 of the largest studies to show that the development of PUR in laparoscopic inguinal hernia repair patients is a multifactorial process. Further studies should be conducted to corroborate our findings. [ABSTRACT FROM AUTHOR]

Abstract: Background: The national incidence of postoperative urinary retention (POUR), its risk factors, and associated outcomes are not well understood. Methods: We identified patients undergoing one of the Surgical Care Improvement Project surgeries using the National Inpatient Sample. By using International Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM), we identified POUR and the outcomes urinary tract infection, noninfectious catheter-related complications, length of stay, and posthospitalization care. Multivariable analysis identified predictors of POUR and its associated outcomes. Results: A total of 415,409 patients, representing 2,077,045 nationally, underwent one of the Surgical Care Improvement Project procedures with 43,030 (2.1%) developing POUR. Age, sex, type of surgery, and medical comorbidities were predictive of POUR with a .71 area under the curve. Patients with POUR had greater odds of having urinary tract infections (odds ratio [OR], 2.3; 95% confidence interval [CI], 2.2–2.5), suffering catheter-related complications (OR, 5.2; 95% CI, 3.8–7.0), and needing additional posthospitalization care (OR, 1.3; 95% CI, 1.25–1.4), and they had a greater length of stay (.24 extra days). Conclusions: Patients at risk for POUR can be identified, and they may benefit from interventions to prevent POUR. [Copyright &y& Elsevier]

Background: Several studies have compared short-term catheterization approaches and have demonstrated no difference in patient satisfaction, but no study has evaluated their costs.Objective: To evaluate the costs of 3 pathways for short-term catheter management in patients diagnosed with urinary retention following pelvic surgery.Study Design: We utilized a Markov decision tree to model costs from the society's perspective. In pathway 1, patients have an indwelling catheter and return to the office for a voiding trial. In pathway 2, patients have an indwelling catheter and discontinue the catheters at home. In pathway 3, patients are taught clean intermittent catheterization postoperatively. We accounted for office visits, emergency department visits, urinary tract infection testing and treatment, transportation, caregiver time, teaching time, and supplies.Results: Clean intermittent catheterization is the least costly catheterization method at $79 per patient, followed by self-removal of the catheter ($128) and office voiding trial ($185). One-way sensitivity analyses showed that the distance between the patient and office and the rates of spontaneous voiding following catheterization had the greatest impact. When patients need to travel >5 miles to the office for catheter removal, self-removal of a catheter is less costly than an office voiding trial. Once it has been determined that patients have urinary retention and require catheterization, clean intermittent catheterization is the most cost-saving option only if the patients are taught clean intermittent catheterization postoperatively. If all patients were to be taught clean intermittent catheterization routinely before surgery, it becomes the most costly option. Based on annual surgical volume, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings would be $420,000 to $7.2 million.Conclusion: Clean intermittent catheterization as initial management of urinary retention following pelvic surgery is the most cost-saving option when it is only taught postoperatively to patients after determining the need for catheterization. When this is not possible, self-removal of an indwelling catheter is the most cost-saving option, especially as the distance between the patient and provider increases. Choosing the optimal management guided by patient and provider factors can lead to substantial cost savings annually in the United States. [ABSTRACT FROM AUTHOR]

To date there is no standardized regimen or evidence-based practical guideline concerning post-void residual (PVR) measurement after urogynecologic surgeries. This survey aimed to evaluate current practice patterns and the approach taken among urogynecologists surrounding PVR measurement. An online survey was sent to members of several urogynecologic societies assessing pre- and postoperative management of patients undergoing urogynecologic surgery. A total of 204 urogynecologists from 21 countries participated in the survey. The vast majority of urogynecologists perform some kind of voiding trial to assess voiding function postoperatively. The cut-off values to perform catheterization, the methods of measurement, and the number of successfully passed voiding showed strong differences. Only 34.4% of the respondents consider routine PVR measurement after urogynecologic surgery to be evidence-based. PVR measurement after urogynecologic surgeries is widely performed and if pathological, it almost always provokes invasive treatment. However, there is a wide variation of implemented strategies, methods, and cut-off values. Scientific societies are challenged to devise a standardized regimen based on evidence for the management of urinary retention after urogynecologic surgery. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify clinical risk factors for increased post-void residual (PVR) volumes in patients undergoing vaginal prolapse surgery and to find out whether uterus preservation or prolapse hysterectomy influences the incidence of postoperative urinary retention. Methods: This retrospective study included women who presented with pelvic organ prolapse (POP) and planned prolapse surgery between January 2017 and July 2019. PVR was assessed postoperatively and increased amounts were defined as incomplete voiding with residual urine volume greater than 150 mL. Results: Increased PVR at the first postoperative day occurred in 31.8% (56/176). Body mass index (BMI) was significantly lower in patients with increased PVR after pelvic floor surgery compared to patients with normal PVR amounts (p = 0.040). Furthermore, during multiple logistic regression analysis, low BMI (p = 0.009) as well as prolapse hysterectomy (p = 0.032) turned out to be the strongest risk factors associated with increased PVR volume. Conclusion: This is the first study identifying prolapse hysterectomy as an independent risk factor for increased PVR after surgical prolapse repair. Our results might be helpful in counseling patients prior to surgery and underline the option of uterus preservation during prolapse surgery in selected cases. [ABSTRACT FROM AUTHOR]

Postoperative urinary retention (POUR) is a common complication after total knee arthroplasty. Currently, there are no clinical data regarding the effects of magnesium sulfate on POUR. Here, we investigated the effects of intraoperative magnesium sulfate infusion in patients with POUR following total knee arthroplasty. We reviewed the medical records of patients who underwent elective unilateral total knee arthroplasty under spinal anesthesia between June 2016 and May 2018. The patients were grouped based on whether they were treated with magnesium (magnesium group) or not (control group). We investigated the incidence of POUR and the postoperative analgesic requirement. Totally, 483 patients were included in the analysis. After propensity score matching with the control group, the magnesium group showed a lower incidence of POUR (odds ratio, 0.49; 95% CI, 0.29–0.83; p = 0.011) and lesser opioid consumption (p = 0.049) than the control group. Multivariate logistic regression analysis revealed that intraoperative continuous infusion of magnesium (p = 0.008) and age (p = 0.001) were significantly related to the incidence of POUR. This retrospective observational study demonstrated that administration of magnesium sulfate was associated with a lower incidence of POUR following total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR. Materials and methods: From January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis. Results: POUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0–7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR. Conclusions: The significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients. [ABSTRACT FROM AUTHOR]