Incidence Of Postoperative Urinary Retention Research Articles

Effect of transcutaneous electrical acupoint stimulation on postoperative urinary function in elderly patients undergoing total hip arthroplasty.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative urinary function in elderly patients undergoing total hip arthroplasty (THA). One hundred and eighty elderly patients undergoing unilateral THA without indwelling urinary catheters were randomly assigned to a TEAS group (90 cases, 3 cases dropped out, 4 cases were eliminated) and a sham TEAS group (90 cases, 1 case dropped out, 4 cases were eliminated). Both groups received fascia iliac block and subarachnoid block anesthesia under ultrasound guidance. The patients in the TEAS group were treated with TEAS at Zhongji (CV 3), Guanyuan (CV 4), and bilateral Huiyang (BL 35), Ciliao (BL 32) 30 minutes before anesthesia initiation, with dissperse-dense wave, frequency of 2 Hz/100 Hz, until 30 minutes after surgery. The patients in the sham TEAS group underwent the same procedure with the device applied at the same acupoints but without electrical stimulation. The incidence of postoperative urinary retention (POUR), time to first void, voiding threshold, urinary adenosine triphosphate (ATP) level, postoperative abnormal voiding status (bladder residual volume, re-catheterization rate, nocturia occurrence), and postoperative incidence of urinary tract infection (UTI) and prosthetic joint infection (PJI) were observed in both groups. The incidence of POUR in the TEAS group was lower than that in the sham TEAS group (P<0.05); the time to first void in the TEAS group was shorter than that in the sham TEAS group (P<0.05); the voiding threshold in the TEAS group was lower than that in the sham TEAS group (P<0.05); the urinary ATP level in the TEAS group was higher than that in the sham TEAS group (P<0.05); the bladder residual volume in the TEAS group was lower than that in the sham TEAS group (P<0.05); the nocturia occurrence in the TEAS group was lower than that in the sham TEAS group (P<0.05). However, there was no statistically significant difference in re-catheterization rate, incidence of UTI, and incidence of PJI between the two groups (P>0.05). TEAS could effectively reduce the occurrence of postoperative urinary retention and improve the postoperative urinary function in elderly patients undergoing THA, which might be related with increasing the urinary ATP level.

Post-operative urinary retention is impacted by neuromuscular block reversal agent choice: A retrospective cohort study in US hospital setting

Study objectivePerioperative 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. DesignRetrospective cohort study utilizing large healthcare database. SettingNon-profit, non-governmental and community and teaching hospitals and health systems from rural and urban areas. Patients61,898 matched adult inpatients and 95,500 matched adult outpatients. InterventionsNeuromuscular block reversal with sugammadex or neostigmine plus glycopyrrolate. MeasurementsIncidence 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. Main resultsThe 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). ConclusionThough 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.

Association between diabetes mellitus and postoperative urinary retention after cerebral angiography.

The aim of this study is to examine the association between diabetes mellitus and postoperative urinary retention on cerebral angiography (including intravascular interventional therapy). 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. 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. 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.

Immediate urinary catheter removal after colorectal surgery with the enhanced recovery after surgery protocol.

The Enhanced Recovery After Surgery protocol for colorectal surgery recommends early urinary catheter (UC) removal after surgery. However, the optimal timing remains controversial. We aimed to evaluate the safety of immediate UC removal and risk factors of postoperative urinary retention (POUR) after colorectal cancer surgery. From November 2019 and April 2022, patients who underwent elective colorectal cancer surgery at Seoul St. Mary's hospital were collected retrospectively. A UC was inserted in the operating room after general anesthesia and removed in the operating room immediately after surgery. The primary outcome was the occurrence of POUR following immediate UC removal after surgery, and the secondary outcomes were the identification of POUR-related risk factors and postoperative complications. Among 737 patients, 81 (10%) had POUR immediately after UC removal. No patient had urinary tract infection. The incidence of POUR was significantly higher in male and in those with a history of urinary disease. However, there were no significant differences in tumor location, surgical procedure, or approach. The mean operative time was significantly longer in the POUR group. Postoperative morbidity and mortality rates did not differ significantly between two groups. Multivariate analysis showed that risk factors for POUR were male, a history of urinary disease, and intrathecal morphine injection. Immediate removal of UC immediately after colorectal surgery is safe and feasible in the trend of ERAS. Male, ahistory of benign prostatic hyperplasia, and intrathecal morphine injection were risk factors for POUR.

Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia

PurposeThis study was designed to evaluate the efficacy of low-frequency electroacupuncture (EA) in the prevention of urinary retention after orthopedic surgery. DesignA double-blind placebo-controlled clinical trial. MethodsEighty patients with spinal anesthesia were randomly allocated into the groups of EA (40 cases) and control (40 cases). In the first group, the EA was applied to four points of SP6, SP9, ST28, and CV2; 4 Hz, retaining for 20 minutes in the postanesthesia care unit (PACU). In the control group, no intervention was applied. The incidence of postoperative urinary retention, incomplete or difficult urination, and the first automatic micturition time since spinal anesthesia were compared between the two groups. FindingsThe incidence of urinary retention and incomplete urination in the EA group was significantly lower than that in the control group; the time to first urination was shorter in the intervention group than in the control group (P < .05). ConclusionsElectroacupuncture after spinal anesthesia improves bladder function and reduces the need for a urinary catheter and its possible complications.

A COMPARATIVE STUDY BETWEEN LASER HEMORRHOIDOPLASTY PROCEDURE VS OPEN HEMORRHOIDECTOMY IN THIRD AND FOURTH DEGREE HEMORRHOIDS.

Haemorrhoids are common anorectal condition which can be dened as a symptomatic enlargement and distal displacement of normal anal cushion. It affects both gender and all ages equally and is believed to be caused by chronic constipation. Haemorrhoids affect the daily routine of the affected individual and common symptoms include rectal bleeding, pain, anal irritation and prolapse. Management of haemorrhoids can be divided into surgical and non-surgical methods and many techniques are used to treat haemorrhoids. All patients cannot be treated with only one procedure and in this study, we are comparing laser haemorrhoidoplasty with open haemorrhoidectomy technique. To compare the outcomes of Objectives: laser haemorrhoidoplasty versus open haemorrhoidectomy among patients presenting with second- and third-degree haemorrhoids. Methodology: A hospital based prospective cross-sectional comparative study design was adopted for our study and the source of our data were the patients attending surgery OPD at Navodaya Medical College with a clinical diagnosis of second and third degree haemorrhoids. Study duration was for 18 months and 80 was our sample size based on sample size calculation. who were recruited based on purposive sampling technique. Once recruited patients were randomly divided into two groups with 40 patients each and one group underwent laser haemorrhoidoplasty and another group underwent open haemorrhoidectomy. All the patients were followed up on day 0, day 1, day 2, day 7, one month and at 6 months postoperatively to record post-operative pain, return to work, wound infection, rectal bleeding and any other complications if encountered. All the ndings were compared between the groups to assess better technique with respect to various parameters included. Majority of the Results: patients were in the age group between 30 to 50 years and male predominance (76.25%) was seen. Bleeding and prolapse were the major complaints and 55% of them presented with 3rd degree haemorrhoids and 45% with 2nd degree haemorrhoids. Patients who underwent laser haemorrhoidoplasty had signicantly lesser duration of surgery, shorter hospital stay and less post-operative pain compared to open haemorrhoidectomy technique. Incidence of post-operative urinary retention, constipation, bleeding, sub-mucous abscess was slightly more among patients who underwent open haemorrhoidectomy compared to laser technique. Also, patient who underwent laser haemorrhoidoplasty returned to work earlier and had no recurrence, while patients who underwent open haemorrhoidectomy took more time to return to work and recurrence was seen in two patients. Laser haemorrhoidoplasty seemed to be Conclusion: better technique compared to open haemorrhoidectomy considering duration of surgery, required hospital stay, post-operative pain, post-operative return to work, constipation, bleeding and other complications. Laser technique had better outcome compared to open technique.

Two-team lateral lymph node dissection assisted by the transanal approach for locally advanced lower rectal cancer: comparison with the conventional transabdominal approach.

An optimal surgical approach to lateral lymph node dissection (LLND) remains controversial. With the recent popularity of transanal total mesorectal excision, a two-team procedure combining the transabdominal and transanal approaches was established as a novel approach to LLND. This study aimed to clarify the safety and feasibility of two-team LLND (2team-LLND) and compare its short-term outcomes with those of conventional transabdominal LLND (Conv-LLND). Between April 2013 and March 2020, 463 patients diagnosed with primary locally advanced rectal cancer underwent a transanal total mesorectal excision; among them, 93 patients who underwent bilateral prophylactic LLND were included in this single-center, retrospective study. Among these patients, 50 and 43 patients underwent Conv-LLND (the Conv-LLND group) and 2team-LLND (the 2team-LLND group), respectively. The short-term outcomes, including the operation time, blood loss volume, number of complications, and number of harvested lymph nodes, were compared between the two groups. The intraoperative and postoperative complications in the 2team-LLND group were equivalent to those in the Conv-LLND group; furthermore, the incidence of postoperative urinary retention in the 2team-LLND group was acceptably low (9%). Compared with the Conv-LLND group, the 2team-LLND group had a significantly shorter operation time (P = 0.003), lower median blood loss (P = 0.02), and higher number of harvested lateral lymph nodes (P = 0.0005). The intraoperative and postoperative complications of 2team-LLND were comparable with those of Conv-LLND. Thus, 2team-LLND was safe and feasible for advanced lower rectal cancer. Moreover, it was superior to Conv-LLND in terms of the operation time, blood loss volume, and number of harvested lateral lymph nodes. Therefore, it can be a promising LLND approach.

Prophylactically Given Tamsulosin in Preventing Postop Urinary Retention in Surgery Under Spinal Anaesthesia

Aim: To determine effect of tamsulosin in the prevention of post operative urinary retention in patients undergoing spinal anesthesia Study design: Randomized control trial Place and duration of study: Urology Department, Mayo Hospital, KEMU, Lahore February 2020- February 2021 Methodology: Only 106 patients (53 individuals in each group) were included in the study with non probability purposive sampling. The patients undergoing surgery under spinal anaesthesia were either given tamsulosin in one group and not given tamsulosin in other group. Postoperatively patients were monitored for urinary retention. SPSS-26 was used for analyzing the data. Result: Incidence of postoperative urinary retention was significantly higher in placebo group as compared to Tamsulosin group. i.e. (overall result of 26.42 vs 3.77%, p-value=0.001 and 26% vs 2.5% in hernia group and 33.3 vs 7.7 % in hydrocele group) Conclusion: Prophylactically given tamsulosin helps in preventing postoperative urinary retention in patients undergoing surgery under spinal anaesthesia. Keywords: Postoperative urinary retention, Tamsulosin, Spinal Anaesthesia

Dexmedetomidine versus fentanyl effect as adjuvants to bupivacaine on post spinal urinary retention in knee joint arthroscopic surgeries

ABSTRACT Background Ambulatory knee surgeries are increasing in frequency, however post spinal urinary retention can represent a hazardous post-operative issue to patients. The aim of this study was to assess the impact of intrathecally injected 5 µg dexmedetomidine, or 25 µg fentanyl as adjuvants to bupivacaine in low dose spinal anesthesia for unilateral arthroscopic knee surgeries, on the incidence of post-operative urinary retention (POUR), the duration of sensory and motor blocks, time to micturition, and the number of patients who needed an indwelling (Foley’s) catheter. Methods Seventy patients, American Society of Anesthesiologists (ASA) physical status I or II, from 21 to 50 years old, were randomly divided into two equal groups: the Bupivacaine-Dexmedetomidine group (BD) patients and the Bupivacaine-Fentanyl group (BF) patients. Results The incidence of POUR was statistically non-significant less in the BD group patients, than in the BF group patients. The duration of sensory and motor blocks, as well as the time to micturition, was comparable between patients in the two groups. No patient in either group required insertion of an indwelling urinary catheter at the sixth post-operative hour. Conclusion In unilateral arthroscopic knee surgeries, the addition of dexmedetomidine to low-dose spinal anesthesia decreased the clinical incidence of POUR compared to the addition of fentanyl.

Postoperative urinary retention following hip or knee arthroplasty under spinal anaesthesia with intrathecal morphine: a retrospective cohort study.

Postoperative urinary retention (POUR) frequently complicates the course of patients following hip and knee arthroplasty. Intrathecal morphine (ITM) was identified as a significant risk factor for POUR. The objective of this study was to investigate the incidence and risk factors for POUR in fast-track total joint arthroplasty (TJA) under spinal anaesthesia (SA) with ITM. We conducted a retrospective study of our institutional joint registry of patients who underwent primary TJA under SA with ITM between October 2017 and May 2021. Preoperative (baseline demographics) and perioperative data were collected. The primary outcome was the incidence of POUR after 8 h or earlier, either due to lack of voiding or according to patient's complaints of bladder distension. Univariate and adjusted analyses were performed to identify predictors of POUR. Sixty-nine patients who underwent total knee arthroplasty (TKA) and 36 patients who underwent total hip arthroplasty (THA) under SA with ITM were included in the study. POUR requiring bladder catheterisation was diagnosed in 21% of patients. Independent predictors of POUR were age over 65 years and male gender. SA with ITM for TJA is associated with high rates of POUR in males older than 65 years of age. Other previously identified risk factors such as intraoperative fluid administration or comorbidities may not be as influential.

Prospective comparative study of mesh fixation in laparoscopic TEP hernia repair using tacker versus cyanoacrylate versus fibrin glue tep mesh fixation with cyanoacrylate

Background: Laparoscopic inguinal hernia repairs done by totally extra peritoneal (TEP) or trans abdominal preperitoneal techniques require mesh fixation which is commonly done by either tackers or fibrin glue. In this study, we discuss about using cyanoacrylate glue for mesh fixation as a more cost effective but equally suitable alternate. Aims and Objectives: The aim of the study was to evaluation of suitability of using highly economical cyanoacrylate ($ 0.13) with tackers ($ 318.52) and fibrin glue ($ 11.94) for mesh fixation during TEP hernia repair. Materials and Methods: A comparative study was done in the Department of Surgery over a period of 3 years (2018–2021). This study included 210 patients who underwent laparoscopic TEP hernia repair. Cases were randomized into three groups of 70 subjects each: Group A - mesh was fixed with tacker, Group B - mesh was fixed using cyanoacrylate, and Group C - mesh was fixed with fibrin glue. Subjects were followed up for 3 months. Type of presentation, diagnosis, and type of mesh fixation were compared to post-operative complications that included pain, seroma, hematoma, and urinary retention findings were recorded and data were statistically analyzed using “SPSS” software. Results: Decreased incidence of post-operative pain (P=0.01) and hematoma was observed in Group B as compared to Groups A and C. Average hospital stay was significantly less in fibrin glue group (P=0.02) and cyanoacrylate group (P=0.02) as compared to tacker group. There was same incidence of postoperative urinary retention (P=0.520) and seroma (P=0.354) formation between all groups. Patients of Group B started daily activities earlier at 15 days follow-up (P=0.032) as compared to Groups A and C. Conclusion: Cyanoacrylate and fibrin glue fixation of mesh in laparoscopic TEP have better outcomes when compared to tackers. Furthermore, as cyanoacrylate is 300 times cheaper than tacker and 10 times cheaper than fibrin glue, this imparts a huge cost advantage to this technique in developing countries. Therefore, use of cyanoacrylate for mesh fixation in laparoscopic TEP can be safely advocated over tackers and fibrin glue.

Preoperative Tamsulosin to Prevent Postoperative Urinary Retention after Pelvic Floor Repair Surgery

<h3>Study Objective</h3> The purpose of the study is to evaluate the effect of preoperative Tamsulosin on postoperative urinary retention (POUR) in patients undergoing surgery for pelvic organ prolapse. <h3>Design</h3> A prospective randomized control trial. <h3>Setting</h3> Patients enrolled in the outpatient clinic setting. Medication given in the preoperative area, the day of surgery. Voiding trial was performed in the post-anesthesia recovery unit (PACU). <h3>Patients or Participants</h3> 100 patients were enrolled with 50 in each arm, randomly assigned. Patients diagnosed with pelvic organ prolapse undergoing vaginal or laparoscopic reconstructive pelvic surgery with or without mid-urethral sling. <h3>Interventions</h3> Oral Tamsulosin 0.4mg given 30-90 minutes before the procedure. Active voiding trial was performed within 4 hours of patients arriving to the PACU. <h3>Measurements and Main Results</h3> 48 patients enrolled in the control group and 47 patients in the study group. When comparing demographics, there were no statistically significant differences between the groups except for preoperative uterine prolapse <i>(p<0.05).</i> For the primary outcome, there was no statistically significant difference in incidence of POUR between the 2 groups <i>(p=0.73).</i> A total of 36 patients had POUR; 17 (36.2%) in the study group and 19 (39.6%) in the placebo group. A multivariate cox regression analysis determined that the study group had a hazard risk of 1.1 [95% CI 0.47-2.59] but was not statistically significant <i>(p=0.81).</i> Preoperative uterine prolapse also had an increase hazard risk of 1.25 [95% CI 0.52-3.04] but also failed to meet statistical significance <i>(p=0.62).</i> Postoperative narcotic use <i>(p=1.0)</i> and increased length of surgery <i>(p=0.51)</i> had no increase in POUR. <h3>Conclusion</h3> In this study, the incidence of POUR was not significantly decreased after a single preoperative dose of Tamsulosin. Receiving Tamsulosin with preoperative uterine prolapse had an increased hazard risk for POUR but was not statistically significant. At this time, we do not recommend a single dose of tamsulosin to decrease POUR after prolapse surgery.

Analysis of the Effectiveness of Transradial Access Puncture in the Application of Complications and Comfort after Cerebral Angiography.

Objective To investigate the analysis of the effectiveness of transradial access puncture in the application of complications and comfort after cerebral angiography. Methods Retrospectively analyzed 80 patients who met the inclusion and exclusion criteria and were randomly divided into the control group (femoral artery group n = 40) and test group (radial artery group n = 40) using a random number table from January 2021 to January 2022 admitted to the department of neurology and department of vascular interventions in our hospital and compared the incidence of postoperative puncture site bleeding, time to first postoperative urination, and incidence of postoperative urinary retention and postoperative changes in comfort level. Results There was 1 case of postoperative puncture site bleeding in the test group and 6 cases of postoperative puncture site bleeding in the control group, with statistically significant differences (P < 0.05); the time to first urination in the test group (62.47) was significantly better than that in the control group (85.97), with statistically significant differences (P < 0.05); there were 0 cases of urinary retention in the test group and 6 cases in the control group, with statistically significant differences (P < 0.05). The GCQ scores of patients in the test group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Transradial access puncture has a good clinical effect and can effectively reduce the complication rate of patients, which is worth promoting.

Postoperative Urinary Retention after Pediatric Orthopedic Surgery.

Purpose: This study aims to describe the incidence of postoperative urinary retention among pediatric patients undergoing orthopedic surgery and identify risk factors. Methods: The Pediatric Health Information System was used to identify children aged 1–18 years who underwent orthopedic surgery. Collected from each patient’s record were demographic information, principal procedure during hospitalization, the presence of neurologic/neuromuscular conditions and other complex chronic medical conditions, the total postoperative length of stay, and the presence of postoperative urinary retention. Results: The overall incidence of postoperative urinary retention was 0.38%. Children with complex chronic neuromuscular conditions (OR 11.54 (95% CI 9.60–13.88), p = < 0.001) and complex chronic non-neuromuscular medical conditions (OR 5.07 (95% CI 4.11–6.25), p ≤ 0.001) had a substantially increased incidence of urinary retention. Surgeries on the spine (OR 3.98 (95% CI 3.28–4.82, p ≤ 0.001) and femur/hip (OR 3.63 (95% CI 3.03–4.36), p ≤ 0.001) were also associated with an increased incidence. Conclusions: Children with complex chronic neuromuscular conditions have a substantially increased risk of experiencing postoperative urinary retention. Complex chronic non-neuromuscular medical conditions and surgeries to the spine, hip, and femur also carry a notably increased risk.

Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: Ameta-analysis of randomized controlled trials.

The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). Six studies were included in this meta-analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37-6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.

Lower Incidence of Postoperative Urinary Retention in Robotic Total Mesorectal Excision for Low Rectal Cancer Compared with Laparoscopic Surgery

Introduction: The incidence and clinical significance of postoperative urinary retention (POUR) remain high. This study aimed to evaluate the incidence of POUR and related risk factors in patients who underwent total mesorectal excision (TMR) for low rectal cancer. Methods: This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of POUR. POUR was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization. Results: Of 555 patients with low rectal cancer, 78 (14.1%) developed POUR. Based on multivariate logistic regression analysis, laparoscopic TMR (odds ratio [OR]; 2.114, 95% confidence interval [CI]; 1.212–3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282–4.450, p = 0.006) were independent risk factors of POUR. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with POUR. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965–2.668, p = 0.068). Conclusion: Laparoscopic approach and postoperative ileus are risk factors for POUR after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of POUR.

Robot-Assisted Simple Prostatectomy vs Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-Analysis of Comparative Trials.

Context: Robot-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP) are two minimally invasive alternatives to simple prostatectomy, which is considered the standard treatment in large prostate glands. It remains unclear which of the two is superior in terms of outcome and complications. Objective: To compare perioperative and functional outcomes of RASP vs EEP. Evidence Acquisition: A systematic review and meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. The database search included clinicaltrials.gov, Medline (via PubMed), CINAHL, and Web of Science and was using the PICO criteria. All comparative trials were considered. Risk of bias was assessed with the revised ROBINS-I tool. Evidence Synthesis: Seven hundred sixty studies were identified, 4 of which were eligible for qualitative and quantitative analysis, reporting on a total of 901 patients with follow-up up to 24 months. Hemoglobin drop (mean difference [MD] confidence interval [CI]: 0.34 g/dL [0.09-0.58]), the rate of blood transfusions (odds ratio [OR] [CI]: 5.01 [1.60-15.61]) catheterization time (MD [CI]: 3.26 days [1.30-5.23]), and length of hospital stay (LoS) (MD [CI]: 1.94 days [1.11-2.76]) were significantly lower in EEP. No significant differences were seen in operating time and enucleation weight. No significant differences were observed in the incidence of postoperative urinary retention, postoperative transient incontinence, and complications graded according to the Clavien-Dindo classification. Functional results were similar, with no significant differences in International Prostate Symptom Score and maximum urinary flow rate at follow-up. Conclusion: Both EEP and RASP offer excellent improvement of symptoms due to prostatic hyperplasia. EEP has lower blood loss, shorter catheterization time, and LoS and should be the first choice if available. RASP remains an attractive alternative for extremely large glands, in concomitant diseases, or whenever EEP is not available. Review Registration Number (PROSPERO): CRD42021226901.

A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery.

Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital's rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons' benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. To reduce the incidence of POUR by implementing a thoracic surgery-specific nurse-led voiding algorithm. Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR-positive cohort had had a lobectomy (P = .05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital's rates of POUR after lobectomy: from 21% to 3%. The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR.

A steady stream of knowledge: decreased urinary retention after implementation of ERAS protocols in ambulatory minimally invasive inguinal hernia repair.

Potential complications after inguinal hernia repair include uncontrolled post-operative pain and post-operative urinary retention (POUR). Enhanced Recovery After Surgery (ERAS) protocols aim to mitigate post-operative morbidity. We study the impact of ERAS measures alongside discharge without a narcotic prescription on post-operative pain and POUR after minimally invasive inguinal hernia repair. A retrospective review of a prospectively maintained database identified patients that underwent minimally invasive inguinal hernia repair at a single institution. Intra-operative data included operative time, narcotic usage, non-narcotic adjunct medication, and fluid administration. Primary outcomes included rates of POUR and uncontrolled post-operative pain. Operations performed after 2018 were included in the ERAS cohort. Uncontrolled post-operative pain was defined as needing additional narcotic prescriptions, admission, or ER visits for post-operative pain. POUR was defined as requiring an indwelling urethral catheter at discharge, admission for retention, or returning to the ER for urinary retention. Between January 2008 and March 2021, 1097 patients who underwent minimally invasive inguinal hernia repair were identified. 91.3% of these procedures were laparoscopic and 8.7% were robotic. Average patient age was 57.4years, 93% were male. Patients receiving care after initiation of the ERAS protocol were significantly less likely to experience POUR when compared to their prior counterparts (1.4% vs. 4.2% p = 0.01); there was no difference in post-operative pain complications (1.4% vs. 2.9% p = 0.15). Patients who were discharged without a narcotic prescription had 0% incidence of POUR. Significant differences were found between the ERAS and non-ERAS cohort regarding narcotic usage and fluid administration. Age, higher fluid volume, and higher narcotic usage were found to be risk factors for POUR while ERAS, sugammadex, and dexamethasone were found to be protective. Implementation of an ambulatory ERAS protocol can significantly decrease urinary retention and narcotic usage rates after minimally invasive inguinal hernia repair.

THE EFFECT OF MEDICATED INTRA-ANAL PACKING ON DECREASING OF ACUTE POST-OPERATIVE URINARY RETENTION INCIDENCE AFTER OPEN HEMORRHOIDECTOMY.

The aim: To evaluate the effect of decreasing post-operative anal pain and spasm on the rate of post-surgical acute urinary obstruction in patients undergoing hemorrhoidectomy. Materials and methods: The study was conducted from April 2013 to April 2019 on 571 patients that were undergoing conventional hemorrhoidectomy. The operation was followed by using the medicated intra-anal packing and then the patients were monitored postoperatively for the first 24 hours for the incidence of postoperative urinary retention. The hypothesis of this study was that the acute urinary retention is the most common post-operative complication of the anal surgeries and that the irritation-blockade mechanism which is induced due to anal skin injury is the main cause of that obstruction. Thus, reducing the incidence of this mechanism will reduce urinary retention and post-operative pain. Results and conclusions: The results found that 569 (99.64%) patients were showed no signs of urinary retention with the exception of only two (0.35%) patients were showed signs of urinary retention. Finally, it was concluded that usage of medicated anal-packing methods was of benefit in decreasing the rate of postoperative urinary retention due to its effect in decreasing postoperative anal pain and spasm.