Risk Of Urinary Retention Research Articles

Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options.

This article provides an overview of the diagnosis and the treatment of lower urinary tract symptoms in older adults complicated by the neurodegenerative changes in the micturition reflex and further confounded by age-related decline in hepatic and renal clearance raising the propensity of adverse drug reactions. The first-line drug treatment for lower urinary tract symptoms, orally administered antimuscarinics, fails to reach the equilibrium dissociation constant of muscarinic receptors even at their maximum plasma concentration and tends to evoke a half-maximal response at a muscarinic receptor occupancy of just 0.206% in the bladder with a minimal difference from exocrine glands, which raises the adverse drug reaction risk. On the contrary, intravesical antimuscarinics are instilled at concentrations 1000-fold higher than the oral maximum plasma concentration and the equilibrium dissociation constant erects a downhill concentration gradient that drives passive diffusion and achieves a mucosal concentration around ten-fold lower than the instilled concentration for a long-lasting occupation of muscarinic receptors in mucosa and sensory nerves. A high local concentration of antimuscarinics in the bladder triggers alternative mechanisms of action and is supposed to engage retrograde transport to nerve cell bodies for neuroplastic changes that underlie a long-lasting therapeutic effect, while an intrinsically lower systemic uptake of the intravesical route lowers the muscarinic receptor occupancy of exocrine glands to lower the adverse drug reaction relative to the oral route. Thus, the traditional pharmacokinetics and pharmacodynamics of oral treatment are upended by intravesical antimuscarinics to generate a dramatic improvement (~ 76%) noted in a meta-analysis of studies enrolling children with neurogenic lower urinary tract symptoms on the primary endpoint of maximum cystometric bladder capacity as well as the secondary endpoints of filling compliance and uninhibited detrusor contractions. The therapeutic success of intravesical multidose oxybutynin solution or oxybutynin entrapped in the polymer for sustained release in the pediatric populationbodes well for patients with lower urinary tract symptoms at the other extreme of the age spectrum. Though generally used to predict oral drug absorption, Lipinski's rule of five can also explain the ten-fold lower systemic uptake from the bladder of positively charged trospium over oxybutynin, a tertiary amine. Chemodenervation by an intradetrusor injection of onabotulinumtoxinA is merited for patients with idiopathic overactive bladder discontinuing oral treatment because of a lack of efficacy. However, age-related peripheral neurodegeneration potentiates the adverse drug reaction risk of urinary retention that motivates the quest of liquid instillation, delivering larger fraction of onabotulinumtoxinA to the mucosa as opposed to muscle by an intradetrusor injection can also probe the neurogenic and myogenic predominance of idiopathic overactive bladder. Overall, the treatment paradigm of lower urinary tract symptoms in older adults should be tailored to individual's overall health status and the risk tolerance for adverse drug reactions.

Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials.

The meta-analysis aimed to integrate the evidence of randomized control trials to estimate the efficacy of prophylactic tamsulosin on postoperative urinary retention (POUR). The PubMed, Embase, Web of Science, and Cochrane Library databases were searched through 1 March 2022 using predetermined keywords. Randomized control trials reporting the preventive efficacy of prophylactic tamsulosin against POUR were identified according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline. Pooled risk ratios (RRs) were calculated using a random-effects model or a fixed-effects model based on the results of heterogeneity assessment. A meta-regression analysis was performed to explore the potential sources of heterogeneity. There were 14 studies with 1102 patients in the Tamsulosin group and 1119 patients in the Control group. The risk of POUR was significantly lower in the Tamsulosin group (156/1102 [14.2%] vs. 238/1119 [21.3%]; RR=0.65; 95% CI: 0.50-0.86; P =0.002; Heterogeneity: I2 =51%; P =0.01). Tamsulosin administration was associated with a higher risk of adverse events (65/614 [10.6%] vs. 39/626 [6.2%]; RR=1.72; 95% CI: 1.19-2.48; P =0.004; Heterogeneity: I2 =0%; P =0.70). The meta-regression identified the mean age of patients as the only potential source of heterogeneity. Subgroup analysis showed that the younger patients (age <50 years) might benefit more from tamsulosin intake (RR=0.36; 95% CI: 0.19-0.70; P =0.003; Heterogeneity: I2 =49%; P =0.14). The current meta-analysis suggested that prophylactic tamsulosin contributed to the prevention of POUR, and younger patients (<50 years) might benefit more from this preventive regimen. Tamsulosin was also associated with a higher risk of adverse events.

Prevalence and Risk Factors of Urinary Retention in Patients With Cervical Cancer: A Meta-analysis and Systematic Review.

The literature is inconsistent on the prevalence and risk factors of urinary retention in patients with cervical cancer. The aim of this study was to review the literature on the prevalence of urinary retention in patients with cervical cancer and consolidate the risk factors. For this meta-analysis, eligible articles published in English or Chinese by December 10, 2021, were systematically searched for and retrieved from PubMed, Cochrane Library, Ovid-Embase Medline, Web of Science, PsycINFO, CINAHL, and Scopus. Prevalence, odds ratios (ORs), and 95% confidence intervals (CIs) were used for meta-analysis. Twenty-five studies were included in the analysis. The pooled overall prevalence was 0.26 (95% CI, 0.21-0.30, I2 = 95.0%). The identified risk factors were age (OR, 1.13; 95% CI, 1.08-1.19), urinary tract infection (UTI) (OR, 3.33; 95% CI, 1.48-7.49), surgical extent (OR, 2.95; 95% CI, 1.27-6.85), and catheter indwelling time (OR, 3.44; 95% CI, 2.43-3.87). The prevalence of urinary retention in patients with cervical cancer is 0.26. Older age, UTI, longer catheter indwelling time, and a larger surgical extent may increase the risk of urinary retention. Clinicians should identify patients at risk and adopt interventions such as individualized catheter care. Nursing staff should assess the risk of urinary retention in a patient with cervical cancer according to her age, presence of UTI, surgical extent, and catheterization time. A carefully chosen surgical procedure and interventions such as individualized education, timely catheter removal, treatment of UTI, and rehabilitation should be offered.

Effect of Pharmacotherapy for Overactive Bladder on the Incidence of and Factors Related to Urinary Tract Infection: A Systematic Review and Meta-analysis.

The aim of this meta-analysis was to investigate the effect of pharmacotherapy for overactive bladder on the pathogenesis of urinary tract infection. A comprehensive search was performed in MEDLINE and the Cochrane Library using terms for overactive bladder, antimuscarinic agents, and beta 3-adrenoceptor agonists. The primary end point was the emergence of urinary tract infection after pharmacotherapy for overactive bladder. The secondary end point was the emergence of urinary retention, dysuria, and/or increased residual urine volume after overactive bladder treatment. Meta-analyses were conducted using random-effects models. A total of 35,939 patients in 33 trials (29 trials of antimuscarinic agents vs placebo, and 9 trials of beta 3-adrenoceptor agonists vs placebo) that included patients with overactive bladder were identified. At 1-3 months after treatment, the incidence of urinary tract infections was statistically significantly higher in the patients treated with antimuscarinic agents (RR: 1.23, 95% CI: 1.04, 1.45; P = .013) than in the placebo control group. The incidence of urinary tract infections was not increased in the patients treated with beta 3-adrenoceptor agonists (RR: 1.04, 95% CI: 0.76, 1.42; P = .796). Antimuscarinic agents also statistically significantly increased the risks of urinary retention, dysuria, and/or increased residual urine volume (RR: 2.88, 95% CI: 1.79, 4.63; P < .001), whereas beta 3-adrenoceptor agonists did not (RR: 1.26, 95% CI: 0.38, 4.14; P = .708). This meta-analysis showed that antimuscarinic agents statistically significantly increased the incidences of urinary tract infection and lower urinary tract symptoms and dysfunction, but beta 3-adrenoceptor agonists did not. To prevent urinary tract infection emergence, beta 3-adrenoceptor agonists might be safer than antimuscarinic agents.

HUBUNGAN INFILTRASI LIMFOSIT PADA PROSTAT DENGAN RETENSI URINE PADA BENIGN PROSTATIC HYPERPLASIA DI RSUD ULIN BANJARMASIN

Benign prostatic hyperplasia (BPH) is a common condition in elderly men. BPH may cause lower urinary tract symptoms (LUTS) and urinary retention. Chronic inflammation is a common founding in histological examination of BPH and related to a higher risk of urinary retention. The purpose of this study is to analyze the association between lymphocyte infiltration in prostate and urinary retention in BPH in Ulin General Hospital Banjarmasin. This is an analytic observational study with cross sectional approach. There are 78 samples, collected by purposive sampling method. There are 47 (60,26%) patients diagnosed with urinary retention, while 31 (39,74%) others are diagnosed with LUTS. Lymphocyte infiltration is found in 68 (87,18%) specimens, consist of 20 (25,64%) specimens of BPH with mild inflammation, 34 (43,59%) specimens of BPH with moderate inflammation, and 14 (17,95%) specimens of BPH with severe inflammation. There is no lymphocyte infiltration found in 10 (12,82%) specimens. The result of the analysis is P = 0,320. The conclusion of this study is that there is no significant association between lymphocyte infiltration in prostate and urinary retention in BPH in Ulin General Hospital Banjarmasin

Prophylactic tamsulosin can reduce the risk of urinary retention after surgery in male patients: A systematic review and meta-analysis

The meta-analysis aimed to estimate the efficacy of prophylactic tamsulosin on postoperative urinary retention (POUR) in male patients. Papers were searched in the PubMed, Embase, Web of Science, and Cochrane Library databases with predetermined keywords up to March 1, 2022. The studies reporting the preventive efficacy of prophylactic tamsulosin on POUR among men were identified. Pooled risk ratios (RRs) were calculated based on the random-effects model. Meta-regression was performed to explore potential sources of heterogeneity. There were 11 studies with 1,046 patients in the tamsulosin group and 1,113 patients in the control group. The risk of POUR was significantly lower in the tamsulosin group (123/1,046 [11.8%] vs. 238/1,119 [19.0%]; RR = 0.61; 95% confidence interval [CI] 0.43 to 0.87; P = 0.006; heterogeneity: I 2 = 57%; P = 0.009). Administration of tamsulosin was related to higher risk of adverse events (57/688 [8.3%] vs. 33/624 [5.3%]; RR = 1.68; 95% CI: 1.13 to 2.48; P = 0.010; heterogeneity: I 2 = 33%; P = 0.20). The level of evidence and mean age of the included patients were identified as the potential sources of heterogeneity. The present meta-analysis indicated that prophylactic tamsulosin helps in preventing POUR and younger patients might benefit more from this preventive regimen. Administrating tamsulosin was also associated with a possibly higher risk of adverse events.

Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation.

Placement of penile prosthesis had been well described in the outpatient setting, however, one barrier to same-day discharge is postoperative urinary retention (POUR). POUR remains a condition encountered during ambulatory surgical procedures and has yet to be characterized in patients undergoing penile prosthesis. We characterized POUR in a cohort of penile prosthesis recipients along with risk factors and management. Patients undergoing penile prosthesis implantation from 2014 through 2020 without pre-existing retention were included. All patients underwent a void trial immediately following penile prosthesis in the post-anesthesia care unit. POUR was strictly defined as (1) any patient requiring catheter replacement after prosthesis, (2) a rising post-void residual, or (3) inability to void after 6 h regardless of whether a catheter was placed. Independent procedures, demographic, intraoperative, and postoperative risk factors for POUR were assessed. 317 men were included of whom 27.1% experienced POUR. Men experiencing POUR and those not in retention were essentially indistinguishable with respect to previously described risk factors for POUR. Only use of both α-blockers and 5-α-reductase inhibitors was significantly associated with a greater risk of POUR, a finding maintained on adjusted analysis (adjusted odds ratio 10.1, 95% confidence interval 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of clean intermittent catheterization (CIC) in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of prosthesis infection in patients who experienced POUR did not significantly differ from those who did not experience POUR (4.7% vs. 2.2% p = 0.26). Our findings suggest that POUR is experienced in as many as 1 in 4 men undergoing penile prosthesis placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic prostate enlargement are at significantly greater risk of urinary retention.

Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis.

Laser hemorrhoidoplasty (LHP) is known as a new minimally invasive and painless procedure for symptomatic hemorrhoids. However, Milligan-Morgan (MM) may offer the best result of long-term cure rates. In this study, we aim to compare the efficacy between LHP and MM for hemorrhoidal disease treatment. Using specific keywords, we comprehensively go through the potential articles on PubMed, Europe PMC, and Google Scholar sources until April 19, 2022. All published studies on LHP and MM hemorrhoidectomy were collected. Statistical analysis was done by using Review Manager 5.4 software. Twelve studies with a total of 1756 patients with hemorrhoid grades II-IV were included for the analysis. Our pooled analysis revealed that LHP was associated with shorter operative time (p < 0.00001), shorter length of hospital stay (p = 0.0005), lower risk of urinary retention (p = 0.005) and anal stenosis (p = 0.0004), and lower VAS 24-h post-operative (p < 0.00001) when compared with MM. However, LHP and MM did not differ in terms of recurrence rate (p = 0.70). LHP was superior to MM procedure in terms of shortening the recovery time and minimizing post-operative complications for patients with hemorrhoidal disease.

Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery

ObjectivesTo determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery. Materials and methodsWe performed a prospective observational cohort study of three surgeons’ practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention. ResultsDuring the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9). ConclusionsVoiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).

Urinary Retention After Hemorrhoidectomy: Can We Reduce Risk?

Objectives: Hemorrhoidectomy is a common surgery and urinary retention (UR) after anorectal surgeries is an unwelcome complication. In this study we aimed to investigate risk of UR after hemorrhoidectomy and predict the factors associated with UR.&#x0D; Methods: Between 2016-2018 years, 180 patients who undergone hemorrhoidectomy by general anesthesia were included study. The patients with urological symptoms and urological surgery before were excluded. &#x0D; Results: Median age of patients was 45.5 (IQR: 40.0-55.0) years. There was 116 (64.4%) of male and 64 (35.6%) of woman. Urinary retention was seen significantly higher in men (p=0.03) but, visual pain scale (VPS) and the analgesic requirement were similar between men and women (p=0.39 and p=0.86, respectively). Regression analysis showed that male gender, operation time and analgesic requirement was not associated UR and the VPS is only predictive factor for UR (OR:0.224, p

CURRENT APPROACHES TO PERIOPERATIVE MANAGEMENT OF PATIENTS WITH INGUINAL HERNIAS (LITERATURE REVIEW)

The article provides literature review on current approaches to perioperative treatment of patients with inguinal hernias (IH) based on the principles of enhanced recovery after surgery (ERAS). The ERAS algorithm includes all evidence-based perioperative elements that affect rapid recovery after surgery, reduce the incidence of complications and potential mortality. There are three stages of patient management: preoperative examination, selection of an adequate method of surgical treatment, anesthesia during surgery and in the postoperative period. Thorough examination of patients before surgery and identification of potential risk factors associated with comorbidities are important to reduce the risk of morbidity and recurrences. Effective dynamic perioperative pain management is a prerequisite for optimal recovery after surgery. The first step in managing pain under the ERAS concept is choosing the correct type of surgery. Preference should be given to the least traumatic operations, i.e., laparoscopic or endoscopic hernioplasty. According to PROSPECT recommendations, analgesics should be started before and continued during surgery, which will provide adequate analgesia in the early postoperative period. The combination of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and a selective cyclooxygenase-2 inhibitor (COX-2) provides good analgesia and reduces opioid use. The transverse abdominal block (TAP block), as a type of regional anesthesia, is safe for patients with IH, reduces the postoperative need for narcotic analgesics, reduces the frequency of postoperative nausea and vomiting and pain intensity. Regional anesthesia reduces the length of a patient’s stay in the operating room and is associated with a lower risk of urinary retention in the postoperative period (compared to neuroaxial anesthesia). After the operation patient should be activated as soon as possible, and this is possible under conditions of sufficient analgesia, which is best achieved by combining systemic analgesics and TAP block. Antimicrobial prophylaxis should be performed in all patients undergoing elective surgery for IH. Since some patients experience significant limitations in daily activities due to chronic postoperative inguinal pain, it is necessary to consider all risk factors for chronic pain after surgery to prevent its development.

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for Uterine Contraction Pain Relief After Cesarean Section: A Randomized, Double-Blind Clinical Trial.

PurposeProgrammed intermittent epidural bolus (PIEB) was reported to provide superior maintenance of labour analgesia with better pain relief and less motor block than continuous epidural infusion (CEI). Whether this is also evident for uterine contraction pain relief after cesarean section remains unknown.Patients and MethodsParturients scheduled for cesarean section were recruited for the study. At the end of the surgery, after a similar epidural loading dose given, patients received either PIEB (6 mL·h−1) or CEI (6 mL·h−1) of 0.1% ropivacaine. The primary outcome was the uterine contraction pain assessed with visual analog scale (VAS-U) at the postoperative 36 h. Secondary outcomes included incision pain at the rest (VAS-R) and in the movement-evoked (VAS-P), and lower extremity motor block (defined as Bromage score > 0). The whole profile of VAS scores between groups was analyzed using linear mixed model. When significant differences were found, the pairwise comparison was done with the Mann Whitney U-test followed by Bonferroni correction.ResultsOne hundred and twenty parturients were studied (PIEB, 60; CEI, 60). VAS-U at the postoperative 36 h in the PIEB group was lower than in the CEI group (Bonferroni-adjusted P < 0.01). The linear mixed model indicated that VAS-U, VAS-R and VAS-P were lower in the PIEB group compared with the CEI group (all P < 0.01). Motor block was higher in the CEI group than in the PIEB group during the study period except 2 h (all P < 0.05). No differences of adverse events such as hypotension and urinary retention were observed between the two groups.ConclusionProgrammed intermittent epidural bolus provides more effective uterine contraction and incision pain relief and less motor block after cesarean section than continuous epidural infusion without an increased risk of urinary retention and blood pressure instability.

Effect of urinary catheter removal on different time after hysterectomy: a network meta-analysis.

The optimal timing for removing urinary catheters is controversial for patients undergoing total hysterectomy. This study aimed to evaluate the optimal time for removing urinary catheters post-hysterectomy. We searched multiple databases from inception till December 31, 2020, for all randomized trials evaluating the timing of catheter removal following hysterectomy. All studies were evaluated by two investigators independently depending on inclusion and exclusion criteria. Network meta-analysis (NMA) was conducted on the data using Stata 14.0 software. A total of 12 articles involving 1814 patients were ultimately included. This study showed removing urinary catheters 12.1 to 24h (pooled OR = 2.67; 95% CI, 1.53‑4.67) and 36.1 to 48h (pooled OR = 8.11;95% CI, 3.78‑17.36) post-hysterectomy increased the risk of urinary tract infection (UTI) compared with immediate catheter removal. Timing of catheter removal in other groups following hysterectomy accompanied a reduced risk of urinary retention (UR) versus immediate catheter removal (P < 0.05). Removal of the urinary catheter from 36.1 to 48h was most likely to lead to UTI. The maximum SUCRA value of immediate catheter removal after hysterectomy was 99.3% for UR. Catheter removal 24.1 to 36h after hysterectomy was the best time for preventing UR. Removal of the catheter immediately after hysterectomy may be the optimal time for preventing UTI with increased risk of UR, whereas removal time of the urinary catheters within 6h post-hysterectomy combined with postoperative urination monitoring might be more beneficial than other removal times following hysterectomy.

Comparison of two different minimally invasive techniques used in bladder stone surgery for preschool-aged children.

This study was designed to compare the outcomes of mini-percutaneous cystolithotomy (mPCL) and transurethral cystolithotripsy (TUCL) in treating bladder stones in preschool-aged children (≤6 years old). Twenty-four patients treated with mPCL and 28 patients treated with TUCL for bladder stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed. The mean age and gender distribution were similar between the groups. The mean stone size was 16.5 ± 0.5 mm for the mPCL group and 14.9 ± 5.7 mm for the TUCL group (p = 0.318). The mean operative time was 41.1 ± 9.9 min for the mPCL group and 39.0 ± 12.3 min for the TUCL group (p = 0.182). Catheterization times and hospitalization times were statistically significantly longer in the mPCL group (p = 0.000). The rate of urinary retention after urethral catheter removal was significantly higher in the TUCL group (p < 0.05). Reintervention was performed for one patient in Group 1 due to urinary leakage and for five patients in Group 2 due to urinary retention. The stone-free rate (SFR) after a single procedure was 100% in the mPCL group and 89.3% in the TUCL group (p = 0.099). After auxiliary procedures performed for three patients, the overall SFR also reached 100% for the TUCL group. Both mPCL and TUCL are effective methods in the treatment of bladder stones of <30 mm in the preschool age group. Although TUCL has some advantages over mPCL, such as shorter hospital stays and catheterization times, there is a risk of urinary retention with increased stone sizes. It may be more advantageous to apply mPCL for the reduction of complications and reintervention rates, especially in small children with bladder stones of >20 mm.

Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients.

Simple SummarySurgery remains a mainstay of combined modality treatment at patients with rectal cancer; however, there is a growing interest in using laparoscopic techniques (LG); including robotic-assisted techniques (RG). Therefore, we have prepared a meta-analysis of the literature regarding the safety and efficacy of robotic versus laparoscopic approaches in patients undergoing curative surgery for rectal cancer. The results indicate a number of advantages of RG in terms of both safety and efficacy. Operative time in the RG group was shorter and associated with a statistically significantly lower conversion of the procedure to open surgery. RG technique provided a shorter duration of hospital stay and lowered urinary risk retention. No differences were found between these techniques regarding TNM stage; N stage or lymph nodes harvested. Survival to hospital discharge or 30-day overall survival rate was 99.6% in RG vs. 98.8% for LG.Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to 10 November 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was 2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD = −0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs. LG group varied and amounted to 8.0 ± 5.3 vs. 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.

The association of statin subgroups with lower urinary tract symptoms following a prostate biopsy.

This was a secondary analysis aiming to assess whether hydrophilic or hydrophobic statins have a differential effect on urinary retention (UR) and lower urinary tract symptoms (LUTS) in men following a prostate biopsy (PBx), who were at risk for prostate cancer development. This was a population-based cohort study with data incorporated from the Institute for Clinical and Evaluative Sciences database to identify all Ontarian men aged 66 and above with a history of a single negative PBx between 1994 and 2016, with no drug prescription history of any of several putative chemo-preventative medications (statins, proton pump inhibitors, five-alpha-reductase inhibitors, and alpha-blockers). Multivariable Cox regression models with time-dependent covariates were used to assess the association of hydrophilic and hydrophobic statins with UR and LUTS within 30 days of a PBx. All models were adjusted for other known putative chemopreventive medications, age, rurality, pharmacologically treated diabetes, comorbidity score, and study inclusion year. Overall, 21 512 men were included, with a median followup time of 9.4 years (interquartile range [IQR] 5.4-13.4 years). Hydrophobic and hydrophilic statins were initiated by 30.7% and 19.6% of men, respectively, after the first negative PBx. UR and LUTS were experienced by 2.2% and 10% of men, respectively. Cox models demonstrated hydrophilic statins were associated with a lower risk of UR (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.38-0.83, p=0.0038) and LUTS (HR 0.86, 95% CI 0.76-0.98, p=0.022), while no such association was shown for hydrophobic statins. Initiation of hydrophilic statins in men older than 66 appears to be inversely associated with the risk of UR and LUTS within 30 days of a PBx.

Quality Improvement Initiative: Foley Catheters in Patients Undergoing Pectus Deformity Repair

Background and Hypothesis: Pectus excavatum and carinatum are sternal deformities that often require surgeries with significant postoperative pain that can limit a patient’s ability to void. An indwelling urinary catheter is placed for the operation, but is often removed on the first postoperative day due to concerns of infection, which begs the necessity of these catheters in the first place. In this study, we hypothesized that there would be no increased risk of urinary retention or urinary tract infection irrespective of whether urinary catheters were utilized.&#x0D; Experimental Design: A pre/post quality improvement study was undertaken of patients undergoing pectus excavatum/carinatum repair between June 1, 2015 and May 31, 2022. The pre intervention group spanned from June 1, 2015 to May 31, 2021, where Foley catheters were placed intraoperatively and removed the first postoperative day. Pediatric surgery and anesthesia groups changed practice effective June 1, 2021 and decided to no longer utilize urinary catheters in pectus repairs. Pre-intervention patients were acquired through the surgery billing database. Post-intervention patients were acquired prospectively. Rates of urinary retention (any event requiring mechanical intervention for voiding) and urinary tract infections (UTI, &gt;100,000 CFU bacteria/mL urine) were compiled into REDCap. Data are expressed as percent of the total cohort.&#x0D; Results: Of 179 patients undergoing pectus repair (162 Excavatum, 17 Carinatum), 12 patients (6.7%) in the pre-intervention group experienced urinary retention. Of these, 9 received in/out catheterization, 1 had a Foley catheter replaced, and 2 underwent in/out catheterization and had a Foley replaced. There were no urinary tract infections recorded among the pre-intervention group.&#x0D; Conclusion and Potential Impacts: Urinary retention and UTI are rare in patients who have an indwelling urinary catheter. Data acquired over the next year from the post-intervention group will help determine the true necessity for these catheters in the perioperative pectus population.

Study of duration and efficacy of chloroprocaine for spinal anesthesia in infraumbilical surgeries

Background: Spinal anesthesia is a reliable and safe technique for infraumbilical surgeries. Nevertheless, some of its characteristics may limit its use for day care surgery. Use of long-acting anesthetic drugs like bupivacaine in spinal anesthesia may lead to side effects such as delayed ambulation and risk of urinary retention. Chloroprocaine is an amino-ester local anesthetic with a very short half-life now being extensively evaluated in volunteer studies and clinical practice with a favorable safety profile and efficacy, suggesting that it may be a suitable alternative to long-acting local anesthetics like bupivacaine in day care surgeries. Aims and Objective: This study aims at evaluating the duration and efficacy of chloroprocaine in spinal anesthesia for infraumbilical surgeries. The primary outcome of the study was to evaluate the duration and efficacy of chloroprocaine 1% in spinal anesthesia for infraumbilical surgeries and the secondary outcome was to find out the incidence of adverse effects if any. Materials and Methods: In this randomized single-blinded clinical evaluation, after institutional ethical committee approval, 30 adult patients (18–70 years, ASA physical Status I-III, BMI &lt; 36 kg/m2) scheduled for infraumbilical surgeries received chloroprocaine 40 mg intrathecally. Patients were evaluated for onset and regression of sensory and motor blockade, peak level of sensory blockade, and time of ambulation postoperatively. Results: The average duration of the surgeries was 46.87±15.24 min. Anesthesia was sufficient for the planned surgery. Only three patients required sedation intraoperatively. The median peak sensory block height was T8. The mean time for peak height sensory block was 6.6±1.673 min and complete motor block was 2±1.05 min. Mean time for complete sensory block regression was 95.37±20.79 min and complete motor block regression was 81.43±20.33 min. Four patients required inj. atropine following bradycardia and three patients required vasopressors following hypotension. Conclusion: Spinal anesthesia with chloroprocaine provides reliable sensory and motor block for short duration infraumbilical surgeries with fewer intraoperative and post-operative complications.

EP.TH.961Meta-analysis of Spinal Anaesthesia Versus General Anaesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia

Abstract Objectives To evaluate comparative outcomes of spinal anaesthesia (SA) and general anaesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia. Methods We systematically searched MEDLINE; EMBASE; CINAHL; CENTRAL, and bibliographic reference lists. Post-operative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 5 studies enrolling 1,518 patients (2,134 hernia) evaluating outcomes of laparoscopic TEP repair under SA (n = 1,277 patients, 1,877 hernia) or GA (n = 241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours (MD: - 0.32, P &amp;lt; 0.0001) and shorter time to normal activities (MD: -0.30, P = 0.002) compared to GA. However, it significantly increased risk of urinary retention (OR:4.02, P = 0.01), hypotension (OR:3.97, P = 0.004), headache (OR:7.65, P = 0.003), and procedure time (MD: 3.82, P = 0.004) There was no significant difference in VAS at 24 hours (MD:0.06, P = 0.34), seroma (OR:1.54, P = 0.26), wound infection (OR:1.03, P = 0.94), and vomiting (OR:0.84, P = 0.66) between two groups. There was a non-significant decrease in overall morbidity in favour GA (OR:1.84, P = 0.17) which became significant following sensitivity analysis (OR:2.59, P = 0.01). Conclusions Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anaesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.

PD18-03 SAFETY AND EFFICACY OF OUTPATIENT SURGICAL PROCEDURES FOR THE TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN NEW YORK STATE AND CALIFORNIA (2005-2016)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-03 SAFETY AND EFFICACY OF OUTPATIENT SURGICAL PROCEDURES FOR THE TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN NEW YORK STATE AND CALIFORNIA (2005-2016) Michelina Stoddard, Xinyan Zheng, Jialin Mao, Alexis Te, Art Sedrakyan, and Bilal Chughtai Michelina StoddardMichelina Stoddard More articles by this author , Xinyan ZhengXinyan Zheng More articles by this author , Jialin MaoJialin Mao More articles by this author , Alexis TeAlexis Te More articles by this author , Art SedrakyanArt Sedrakyan More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral prostatectomy (TURP) and Laser prostatectomy (Laser) have become the gold standard for treatment of benign prostate enlargement (BPE). Randomized controlled trials comparing the safety and efficacy of TURP versus Laser have shown that Laser was non-inferior to TURP with similar short-term durability. However, these studies were performed in high volume centers with expert surgeons and may not represent real-world outcomes. To understand the outcomes of TURP versus Laser in a generalized population, we sought to determine the short- and long-term safety and efficacy of TURP versus Laser in the outpatient setting using real-world data from two large states in the US. METHODS: We present a prospectively collected observational cohort study of 85,682 men with benign prostatic enlargement in New York State and California who received transurethral prostatectomy or laser prostatectomy in outpatient and ambulatory surgery settings from January 2005 to December 2016. We used propensity score matching to adjust for differences in patient characteristics between groups. We analyzed short-term outcomes using mixed-effect logistic regressions and long-term outcomes using Cox regressions with a time-dependent treatment variable to account for non-proportionality. We performed a sensitivity analysis using multivariable regression models. RESULTS: Patients were aged 70.5±9.7 years (mean±SD) and mostly of white race (71%) with a median follow-up period of 3.8 (interquartile range 1.8—6.3) years. Relative to Laser recipients, TURP recipients had increased risks of 30-day hospital readmission/emergency room visit (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.04—1.13, p<0.001); 90-day risks of urinary retention (OR 1.45, CI 1.28—1.65, p<0.001), and hematuria (OR 1.56, CI 1.29—1.89, p<0.001); and higher rate of urethral stricture within 6 months of the index procedure (hazard ratio (HR) 1.47, CI 1.22—1.75, p<0.001). There was no significant difference in the risk of UTI 90 days after the index procedure (OR 0.97, CI 0.85—1.11, p>0.05), and decreased long-term risk of reoperation (HR 0.81, CI 0.76—0.88, p<0.001). CONCLUSIONS: TURP was associated with higher risk of short- and long-term complications, but a lower rate of long-term reoperation than Laser for BPE. Therefore, TURP may be more suitable for patients who are willing and/or able to tolerate more complications at the trade-off of lower risk of reoperation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e356-e356 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelina Stoddard More articles by this author Xinyan Zheng More articles by this author Jialin Mao More articles by this author Alexis Te More articles by this author Art Sedrakyan More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement Loading ...