Abstract
Background:Postoperative urinary retention (POUR) is a common problem in adult neurosurgical patients. The incidence of POUR is unknown and the etiology has not been well established. POUR can lead to urogenital damage, prolonged hospital stay, higher cost, and infection. This study elucidates several risk factors that contribute to POUR in a variety of neurosurgical patients in one institution.Methods:A total of 137 neurosurgical patients were prospectively followed up for the development of POUR, which we defined as initial postvoid residual (PVR1) >250 ml 6 hours after removal of an indwelling urinary catheter (IUC). For patients with PVR >250 ml on the third check, IUCs were reinserted and kept in for 5-7 days.Results:Of the 137 patients, 68 (50%) were male, 41% (56/137) were 60 years or older, 86% (118/137) underwent spinal surgery, and 54% (74/137) had anesthesia over 200 minutes. Overall incidence of clinical POUR was 39.4% (54/137). Significantly higher rates of PVR1 >250 were noted in males, patients older than 60 years, and those who underwent spine surgery. When considering all patient characteristics (except selective alpha blockers), only gender, surgery time, and surgery type remained significant. In addition, PVR1 >250 was positively associated with longer length of stay. Of all patients, 24 (18%) had IUCs reinserted postoperatively or should have had one (5 refused and 2 had a third PVR). The association of IUC reinsertion with male gender was significant.Conclusion:Male gender, time of anesthesia >200 minutes, older age, and spinal surgery are the most significant risk factors associated with POUR in neurosurgical patients.
Highlights
Postoperative urinary retention (POUR) is a common problem in adult neurosurgical patients
Postoperative urinary retention (POUR) is a common problem across many surgical specialties.[1]. Some may regard it as a minor complication; it can lead to significant pain, anxiety, and cost, as well as prolonged hospital stay for many patients.[4,5,16,19,21,24]
Surgical Neurology International 2013, 4:61 catheterization can lead to urethral strictures, trauma, infection, and possibly delirium.[4]
Summary
A total of 137 neurosurgical patients were prospectively followed up for the development of POUR, which we defined as initial postvoid residual (PVR1) >250 ml 6 hours after removal of an indwelling urinary catheter (IUC). POUR, per hospital protocol, was defined as an initial postvoid residual (PVR1) greater than 250 ml using bladder ultrasonography (BVI 3000, Verathon) 6 hours after the removal of indwelling urinary catheters (IUCs) that were inserted during the time of surgery. Kruskal–Wallis test, and Spearman’s correlation coefficients were used to assess the associations between PVR1 and demographic, medical, and surgical information These methods were used instead of standard parametric methods because of the wide distribution of values for PVR1 which ranged from 0 to 1000. All statistical analyses were done using SAS (Cary, NC, USA) version 9.2
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