Risk Of Urinary Retention Research Articles

Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy.

PurposeThis study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.MethodsThis retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.ResultsAmong the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57–2.68; P=0.001) than those who did not.ConclusionMale sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.

Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION\u2014a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers\u2019 implementation strategy

BackgroundThe Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications.Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging.MethodsTwenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support.Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care.During the implementation intervention, all events are recorded, and the facilitators keep diaries.Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation.Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes.DiscussionThe OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

Meta-analysis and trial sequential analysis of randomized evidence comparing general anesthesia vs regional anesthesia for laparoscopic cholecystectomy.

BACKGROUNDIn an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy, the outcomes of such procedure under regional anesthesia (RA) have been evaluated. In the context of cholecystectomy, combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIMTo evaluate comparative outcomes of RA and general anesthesia (GA) in patients undergoing laparoscopic cholecystectomy.METHODSA comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTSThirteen randomized controlled trials enrolling 1111 patients were included. The study populations in the RA and GA groups were of comparable age (P = 0.41), gender (P = 0.98) and body mass index (P = 0.24). The conversion rate from RA to GA was 2.3%. RA was associated with significantly less postoperative pain at 4 h [mean difference (MD): - 2.22, P < 0.00001], 8 h (MD: -1.53, P = 0.0006), 12 h (MD: -2.08, P < 0.00001), and 24 h (MD: -0.90, P < 0.00001) compared to GA. Moreover, it was associated with significantly lower rate of nausea and vomiting [risk ratio (RR): 0.40, P < 0.0001]. However, RA significantly increased postoperative headaches (RR: 4.69, P = 0.03), and urinary retention (RR: 2.73, P = 0.03). The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes, with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSIONOur findings indicate that RA may be an attractive anesthetic modality for day-case laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA. However, its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.

Effect of ERAS Combined with Low-frequency Pulsed Electronic Bladder Therapy Instrument on Patients Who Received PPH

Objective: To assess effect of enhanced recovery after surgery (ERAS) combined with low-frequency pulsed electronic bladder therapy instrument on patients who received procedure for prolapse and hemorrhoids (PPH). Methods: rom January 2020 to December 2020, we collected valid data from 172 patients. According to the random number table method, the participants were divided into intervention group and control group, 86 cases in each group. We provided traditional nursing intervention to control group participants during non-surgery period. In addition, we provided ERAS combined with low-frequency pulsed electronic bladder therapy instrument to intervention group participants. Result: intervention group had better outcome in time of first exhaust, time of activity out of bed, and time of hospital stay compare with control group, that the results were significantly different (p < 0.05). In degree of wound pain of patient, NRS scores in preoperative, six hours after surgery, and 24 hours after surgery were lower in intervention compare with control group, that the results were significantly different. Conclusion: RAS combined with low-frequency pulsed electronic bladder therapy instrument can reduce wound pain of patient, and it speeds patient recovery, promotes early urination after surgery, reduces the risk of urinary retention, and shortens the length of hospital stay.

New agent offers once-daily oral treatment option for overactive bladder

New agent offers once-daily oral treatment option for overactive bladder

Does inguinal hernia repair increase urinary retention? Our 10-year results

Background: This study aimed to determine the incidence of urinary retention in patients undergoing inguinal hernia repair at our hospital as well as the predictors of urinary retention.Methods: Patients who underwent inguinal hernia repair at Lokman Hekim university Akay hospital between January 2010 and January 2020 were included in the study. The total number of patients was 578. The patients were divided into two groups: group-1 (patients who developed urinary retention following inguinal hernia repair) and group-2 (patients who did not develop urinary retention following inguinal hernia repair). The relationship between urinary retention and age, history of preoperative BPH, type and localization of hernia, operative and anesthesia time, perioperative NSAID, narcotic analgesic and antispasmodic use, presence of DM and rheumatic diseases and perioperative fluid replacement was investigated. Results: The median ages were 57.7±15.1 (20-74) and 48.8±17.5 (18-89) in groups 1 and 2, respectively (p&lt;0.001). 5.36% (31/578) of the patients developed urinary retention. The group-1 were found to be at a more advanced age (p&lt;0.001), have higher rates of BPH and DM (p&lt;0.001), longer operative time (p&lt;0.001), higher rate of perioperative antispasmodic use (p&lt;0.001), higher rate of perioperative fluid replacement (p&lt;0.001) and a lower rate of perioperative NSAID use (p&lt;0.001) compared to those who did not develop postoperative urinary retention. Conclusions: According to the results of this study, advanced age, history of DM and BPH, antispasmodic use, longer operative time, high amount of postoperative fluid replacement and no perioperative use of NSAIDs lead to an increased risk of urinary retention.

Does prior surgical interventional therapy for BPH affect the oncological or functional outcomes after primary whole-gland prostate cryoablation for localized prostate cancer?

To assess whether prior interventional treatment for benign prostatic hyperplasia (BPH) influences oncologic or functional outcomes following primary whole-gland prostate cryoablation. Among 3831 men with prostate cancer who underwent primary whole-gland prostate cryoablation, we identified 160 with a history of prior BPH interventional therapy including transurethral needle ablation (n = 6), transurethral microwave thermotherapy (n = 9), or transurethral resection of the prostate (n = 145). Patients with a history of medically treated or unspecified BPH therapy were excluded from the study. Oncological and functional outcomes were compared between men with and without prior BPH interventional therapy. In unadjusted analyses, prior interventional BPH therapy was associated with higher risks of postoperative urinary retention (17.5% vs. 9.6%, p = 0.001) and new-onset urinary incontinence (39.9% vs. 19.4%, p > 0.001) compared with no prior therapy. Interventional BPH therapy was not correlated with the risk of developing a rectourethral fistula (p = 0.84) or new-onset erectile dysfunction (ED) at 12 months (p = 0.08) following surgery. On multivariable regression, prior interventional BPH therapy was associated with increased risk of urinary retention (OR 1.9, 95%, p = 0.015) and new-onset urinary incontinence (OR 2.13, p < 0.001). The estimated 5 years Kaplan-Meier survival analysis showed no statistically significant difference (p = 0.3) in biochemical progression free survival between those who underwent interventional BPH therapy compared with those who did not. Local disease recurrence assessed by post cryoablation positive for-cause prostate biopsy showed no significant difference between the two groups (25.4% vs. 28.7%, p = 0.59). Prior interventional BPH therapy did not affect the oncologic outcomes nor did it increase the risk of rectourethral fistula or ED in sexually performing patients prior to cryosurgery. Prior interventional BPH therapy was associated with increased risk of urinary retention and incontinence after primary whole-gland prostate cryoablation for prostate cancer.

Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined.

Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07-1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

A Retrospective Cohort Study of Effects of Antihypertensive and Anticholinergic Medications on Outcomes Following Elective Posterior Lumbar Spine Surgery.

This was a retrospective consecutive cohort analysis. This study aimed to examine the association between commonly prescribed medications and outcomes following posterior lumbar spine surgery. Postoperative complications and prolonged length of stay significantly increase costs following posterior lumbar spine surgery and worsen patient outcomes. To control costs and complications, providers should focus on modifiable risk factors, such as preoperative medications. Antihypertensive and anticholinergic drugs are among the most commonly prescribed medications but can carry significant risks in the perioperative period. This study was a retrospective cohort analysis of patients undergoing posterior lumbar spine surgery from January 2014 through December 2015 at a large tertiary care center. The variable selection followed by multivariable logistic and negative binomial regressions were performed. An α threshold of 0.0056 was used for significance after correction for multiple comparisons. A secondary analysis was performed to evaluate confounding or effect modifying variables. This study included 1577 patients. Postoperative urinary retention risk was increased in patients taking loop diuretics. Acute kidney injury risk was increased for patients on nondihydropyridine calcium-channel blockers. Surgical site infection risk was increased for patients on aldosterone receptor blockers. Urinary tract infection risk was increased for patients on anticholinergics for urinary incontinence. Length of stay was decreased for patients on angiotensin II antagonists and angiotensin-converting enzyme inhibitors. A care path should be established in the perioperative period for patients who are deemed to be at higher risk due to medication status to either modify medications or improve postoperative monitoring. Level III.

Factors that predict urinary retention in patients who underwent inguinal hernia repair

Background: Some of the patients that undergo inguinal hernia repair develop urinary retention. We aimed to determine the rate of development of urinary retention and predicting factors after inguinal hernia repair.Methods: Patients who underwent inguinal hernia in our center from January 2017 to January 2020 were included in the study. Patients were examined in 2 groups; group1 (developed urinary retention after inguinal hernia repair) and group 2 (did not develop urinary retention after inguinal hernia repair). We investigated the relationship between the development of urinary retention with age, perioperative history of benign prostate obtruction, hernia type and localization, duration of surgery and anesthesia, perioperative non-steroidal anti-inflammatory drug (NSAID), narcotic analgesic and antispasmolytic use, having diabetus mellitus (DM) and rheumatoid diseases, and perioperative fluid replacement.Results: in group 1 and group 2, urinary retention developed in 11 (7.6%) of the patients. Patients who developed post-urinary retention were older than those without urinary retention (p=0.007). The BPO, DM rates were higher (p=0.0001), anesthesia and operation times were longer (p=0.003; p=0.0001); perioperative antispasmolytic use was higher (p=0.0001); we determined that postoperative fluid replacement rate was higher (p=0.003) and the rate of preoperative NSAID use was lower (p=0.0001). Clavien grade 4 and grade 5 complications were not observed in patients.Conclusions: Elderliness, DM history, antispasmolytic use, long operation and anesthesia duration, excessive postoperative fluid replacement and, not using perioperative NSAID increases the risk of urinary retention.

Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia.

To investigate the feasibility of a freehand transperineal (TP) systematic prostate biopsy protocol under local anaesthesia (LA) and the value of different sectors in diagnosing prostate cancer (PCa). A total of 611 consecutive freehand TP biopsies under LA in 2 hospitals were prospectively evaluated. Cancer detection rate in each of the four different sectors (anterior, mid, posterior, basal) was recorded to evaluate the value of each sector. Procedure tolerability was assessed by pain score and complications were documented. Systematic biopsies were performed in 556 out of 611 men with a median of 20 (IQR 12-24) biopsy cores taken. The median PSA was 9.9 (Inter-quartile range[IQR] 6.4-16.2) ng/mL, and 89.0% were first biopsies. All PCa and ISUP grade group (GG) ≥ 2 PCa (HGPCa) were diagnosed in 41.4% (230/556) and 28.2% (157/556) biopsies respectively. 77.0% HGPCa was diagnosed in ≥2 sectors. Single-sector HGPCa was predominantly found in anterior or posterior sector. Omitting base sector would have missed 1.5% (1/65) HGPCa out of the 219 cases with ≥24-core biopsies performed. Further omission of mid sector would have missed 3.1% (2/65) HGPCa and 7.4% (7/94) ISUP GG1 PCa (in which 3/7 involved 2 sectors). LA TP biopsy was well tolerated and the mean pain scores of the different steps of the procedure were between 1.9-3.1 (out of 10). Post-biopsy fever occurred in 0.3% of patients (2/611) and no sepsis was reported. The risk of urinary retention in men with ≥20 cores in ≥60 ml prostate was 7.8% (14/179), compared with 1.7% (7/423) in other groups (p < 0.001). TP sectoral prostate biopsy under LA was well tolerated with minimal sepsis risk. Basal sector biopsies had minimal additional value to HGPCa detection and its omission can be considered.

Estimating acute urinary retention risk post prostate high dose-rate (HDR) brachytherapy: A clinical-based recursive partitioning analysis

PurposeTo determine factors associated with need for post-procedural catheterization in prostate cancer patients treated with 15 Gy high dose-rate brachytherapy boost (HDR-BT). Material and methodsPatients treated with 15 Gy HDR-BT followed by EBRT were retrospectively evaluated for development of urinary retention and hematuria requiring catheterization in the first 30 days post procedure. Clinical characteristics and treatment details were obtained and used as independent variables under study. Univariable and multivariable logistic regression analysis were used to determine predictors of post brachytherapy complications and a classification tree for risk of urinary retention was created using recursive partitioning analysis (RPA). ResultsA total of 425 patients treated with 15 Gy HDR-BT were included in this analysis. 27 patients (6.3%) required catheter placement due to acute urinary retention and thirteen other patients (3%) developed hematuria requiring urinary catheter insertion ± continuous bladder irrigation. Number of needles, prostate volume and prior use of ADT, alpha-blockers or 5α-reductase inhibitors were statistically associated with urinary retention in the univariable logistic regression analysis. In multivariable analysis, prostate volume, previous use of alpha-blocker, and use of ADT remained significant. In the RPA, populations were identified in which the rate of urinary retention ranged from 2% to 50% depending on presence of one or more of these risk factors. ConclusionThe overall rate of acute urinary complications post HDR brachytherapy is low, but the individual risk of urinary retention can increase depending on the number of risk factors present. A more patient-directed retention risk estimation can be performed by using the classification risk tree presented here.

Postpartum urinary retention in women undergoing instrumental delivery: A cross-sectional analytical study.

Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long-term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery. Pregnant women who had an instrumental delivery after 37weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post-void residual volume of >150mL, 6hours after delivery. Demographic factors, clinical profile and follow-up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR=4.05, 95% CI 2.02-8.12 compared with multiparity) and prolonged second stage (OR=3.96, 95% CI 1.53-10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P=.010). Among nulliparous women, those with episiotomy (adjusted OR=6.10, 95% CI 2.65-14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy. Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long-term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.

Early urinary catheter removal after rectal surgery: systematic review and meta-analysis.

BackgroundUrinary catheters are placed after rectal surgery to prevent urinary retention, but prolonged use may increase the risk of urinary tract infection (UTI). This review evaluated the non‐inferiority of early urinary catheter removal compared with late removal for acute urinary retention risk after rectal surgery.MethodsMEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1980 to February 2019. RCTs comparing early versus late catheter removal after rectal surgery were eligible. Primary outcomes were acute urinary retention and UTI; the secondary outcome was length of hospital stay. Early catheter removal was defined as removal up to 2 days after surgery, with late removal after postoperative day 2. The non‐inferiority margin from an included trial was used for analysis of change in urinary retention (ΔNI = 15 per cent). Pooled estimates of risk differences (RDs) were derived from random‐effects models. Risk of bias was assessed using a modified Cochrane risk‐of‐bias tool.ResultsFour trials were included, consisting of 409 patients. There was insufficient evidence to conclude non‐inferiority of early versus late catheter removal for acute urinary retention (RD 9 (90 per cent c.i. −1 to 19) per cent; P NI = 0·31). Early catheter removal was superior for UTI (RD −11 (95 per cent c.i. −17 to −4) per cent; P = 0·001). Results for length of stay were mixed. There were insufficient data to conduct subgroup analyses.ConclusionThe existing literature is inconclusive for non‐inferiority of early versus late urinary catheter removal for acute urinary retention. Early catheter removal is superior in terms of reducing the risk of UTI.

Immediate catheter removal after laparoscopic hysterectomy: A retrospective analysis

ObjectivesAll patients undergoing a laparoscopic hysterectomy receive an indwelling catheter during surgery. The optimum timing of removal of the catheter is uncertain. A possible advantage of leaving the catheter in up to 12 h after surgery is to reduce the risk of urinary retention. Possible disadvantages are patient discomfort and increased risk of urinary tract infection.Timing of removal of the catheter after laparoscopic hysterectomy has not been studied. Previous studies have assessed timing of catheter removal after abdominal hysterectomy. In these studies immediate removal seems safe and feasible after an uncomplicated hysterectomy.In 2015 immediate catheter removal after an uncomplicated hysterectomy was introduced in our clinic.We performed a retrospective analysis of all patients who underwent a laparoscopic hysterectomy. The primary objective of this study was to evaluate the rate of urinary retentions and the secondary objective was to investigate the rate of urinary tract infections when the indwelling catheter was removed immediate after surgery. Study designWe included all women who underwent a laparoscopic hysterectomy from April 2015 until December 2017. Informed consent was obtained from all patients. Medical records were analysed to identify baseline characteristics, surgical details and complications. General practitioners of the included patients were contacted to check for post-operative urinary tract infection up to 6 weeks after surgery. Results325 patients underwent an uncomplicated hysterectomy between April 2015 and December 2017. After informed consent we ultimately included 242 cases in our analysis. The mean age of our study population was 50 years. In 194 (802 %) patients the catheter was removed immediately after surgery. Main reason for delayed removal of the catheter was resection of deep endometriosis (n = 21). The incidence of urinary retention was 4,6 % (95 % CI 2,3–8,3 %) in the immediate removal group. In these 9 cases, 5 (2,6 %) where solved after single catheterisation. The remaining 4 patients (2,0 %) had an indwelling catheter for 24 h after which the urinary retention resolved. The incidence of urinary tract infection was 9,3 % (95 % CI 5,8−14,0- %), when the catheter was removed immediately after surgery.The incidence of urinary retention and UTI were respectively 2,1% (95 % CI 0,1–9,8%) and 208 % (95 % CI 11,1–34,0 %) in the cases with delayed catheter removal (N = 48). ConclusionImmediate removal of the urine catheter after uncomplicated hysterectomy is safe and results in low levels of urinary retention.

PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES Bjoern Volkmer*, Kassel Germany, and Richard Hautmann Bjoern Volkmer*Bjoern Volkmer* More articles by this author , Kassel GermanyKassel Germany More articles by this author , and Richard HautmannRichard Hautmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ileal neobladder (INB) has now been performed on a regular basis for more than 30 years at our institution. This study aims to assess the long term functional outcomes including near normal voiding function, continence, incidence of UTI and metabolic requirements. METHODS: From our consecutive series of 893 male patients who underwent radical cystectomy (RC) and urinary diversion with the INB from 1986 to 2009 we only included those with minimum follow-up of 5 years. We excluded patients with previous irradiation therapy of abdomen or pelvis, with previous other forms of urinary diversion, and with postoperative tumor recurrence. Between 10/08 and 03/09 questionnaires were sent to the remaining 303 patients, with telephone-interviews in those, who did not respond. 44 patients were not available: Death with NED in n=43, living abroad n=6, and n=5 with Alzheimer’s. The remaining 259 patients formed the study population. Continence was defined as use of not more than 1 pad/daytime or nighttime. Patients were asked for the number of feverish UTI within the last 5 years, problems with mucus production, and requirement of (self)catheterization. RESULTS: The mean age at the time of surgery was 60.6±10y ranging from 23y to 81y. The mean time of follow-up in this series was 131±56mon ranging from 60mon to 267mon. The mean age at the time of the survey was 73±10y ranging from 43y to 92y. While the risk of urinary retention and bicarbonate therapy decreased over time, the changes in the rate of daytime and nighttime incontinence seemed to be attributed more to age than to the length of follow-up (Table 1). Transurethral catheters were required in 1 case after 12, in 2 cases after 16 and 17 years postoperatively. Three patients are on substitution of vitamin B12, one patient is on colestyramine therapy for short bowel syndrome. One patient developed end stage renal failure 5 years after surgery. CONCLUSIONS: INB patients who survived more than 5 years after RC and diversion enjoy acceptable urinary continence and retain their ability to void spontaneously in >90 % of patients. The percentage of recurrent UTI and the need of bicarbonate therapy are not negligible. Especially in young patients with favourable pathologic findings an ileal neobladder provides excellent results even after 20 years and more. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e822 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bjoern Volkmer* More articles by this author Kassel Germany More articles by this author Richard Hautmann More articles by this author Expand All Advertisement PDF downloadLoading ...

Is Hysterectomy a Risk Factor for Urinary Retention? A Retrospective Matched Case Control Study

Compare the rates of urinary retention in patients undergoing endoscopic hysterectomy with those of patients undergoing nonhysterectomy endoscopic gynecologic surgery. Retrospective case control study matched by operative time. Academic medical center. All patients undergoing endoscopic gynecologic surgeries between January 2013 and December 2018. Outpatient endoscopic gynecologic surgery. A total of 200 endoscopic hysterectomy cases were matched to endoscopic nonhysterectomy gynecologic surgery controls in a 1:1 ratio. The differences in baseline and operative characteristics between the 2 groups included age (48.6 years vs 45.7 years, p = .04), perioperative opioid administration (morphine milligram equivalents, 11.6 mg vs 7.6 mg, p = .01), and estimated blood loss (64.1 mL vs 31.8 mL, p = .001). The rate of urinary retention in the hysterectomy group was double that in the nonhysterectomy group (26.5% vs 13%, p = .01). In the hysterectomy group, age, perioperative opioids, operative time, and estimated blood loss did not differ between those who failed and those who passed the void trial. In the nonhysterectomy group, only operative time was significantly longer in those who failed the void trial (108 minutes vs 94.3 minutes, p = .04). After adjusting for perioperative opioid use and operative time, the relative risk of urinary retention in the hysterectomy group was 2.3 (p = .002, 95% confidence interval, 1.38-3.98). Hysterectomy appears to be an independent and major factor contributing to postoperative urinary retention. When compared with nonhysterectomy gynecologic surgical controls with similar operative times, the rate of urinary retention in patients who underwent hysterectomy was doubled.

Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis

ObjectivesIn bladder drainage, an essential part of post-hysterectomy care, the optimal timing for removing the urinary catheter is unclear. Our objective was to evaluate the risks and benefits of early (<6 h) vs delayed (>6 h) catheter removal post-hysterectomy. Study designA systematic review searching MEDLINE, EMBASE and Cochrane CENTRAL from inception till May 2019 for randomised trials of women undergoing hysterectomy. We reported on urinary retention, positive urine culture, urinary tract infection (UTI) (defined by symptoms and/or antibiotic use), post-operative pyrexia, time to ambulation, and length of hospital stay. We assessed risk of bias in included trials and used a random-effect model to generate risk ratios (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95 % confidence intervals (CI). ResultsOf 1020 potentially relevant citations, we included 10 randomised trials (1120 women). Four trials had low risk of bias for randomisation and allocation concealment while five had low risk for outcome assessment and selective reporting. Compared to delayed removal, women in the early catheter removal group had a higher risk of urinary retention and needing re-catheterisation (10 RCTs, RR 3.61, 95 %CI 1.21–9.21, I2 = 56 %). There was some reduction in the risk of post-operative UTI (6 RCTs, RR 0.42, 95 %CI 0.18 to 0.96, I2 = 0 %), but we did not find a significant difference in post-operative pyrexia (6 RCTs, RR 0.73, 95 %CI 0.43–1.24, I2 = 18 %) or positive urine cultures (6 RCTs, RR of 0.56, 95 %CI 0.27–1.12, I2 = 55 %). There was no significant difference in the average time to ambulation (3RCTs, WMD −4.6, 95 %CI −9.16 to −0.18, I2 = 98 %) and length of hospital stay (3RCTs, WMD −1.05, 95 %CI −2.42 to 0.31, I2 = 98 %). Our meta-regression on the provision of prophylactic antibiotics did not show a significant effect on the reported outcomes. Our analysis was limited by our inability to adjust for potential effect modifiers such as the surgical route. ConclusionsEarly removal of the urinary catheter <6 h post-hysterectomy seems to increase the risk of urinary retention and needing re-catheterisation, but may reduce post-operative UTI.

Without Urinary Catheter During Perioperative Period of Microvascular Decompression of Trigeminal Neuralgia: The Inspiration Under the Concept of Rapid Recovery

Objective: To determine the effect and advantages of no indwelling catheter during perioperative period of microvascular decompression for trigeminal neuralgia under the concept of rapid recovery. Methods: 30 patients underwent microvascular decompression for trigeminal neuralgia at our hospital during February 2017 and December 2019 were collected and divided into experimental group and control group by whether patients adopted urinary catheter or not at the concept of rapid recovery. The data of gender, age, operation time, intraoperative blood loss, urine tract infection, incidence of urinary retention, urinary comfort and average postoperative hospital stay were collected and compared. Results: No significant difference in gender, age, operation time, intraoperative blood loss (P > 0.05) between those two groups. The intraoperative fluid infusion and urine output in the control group were significantly higher than those in the experimental group. There was no significant difference in urine tract infection and urinary retention in these two groups (P > 0.05), comfort level (P 0.05). Conclusions: Microvascular decompression for trigeminal neuralgia without urinary catheter during perioperative period under the concept of rapid recovery is feasible and safe, will not increase risk of urinary retention, improve postoperative comfort and shorten average postoperative hospital stay.

Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair: A New Technique and Initial Experience

ObjectiveTo address renewed interest in nonmesh transvaginal Pelvic Organ Prolapse (POP) repair since the FDA reclassification of transvaginal mesh, our goal was to develop a transvaginal sacrospinous fixation for anterior and apical POP using only autologous fascia lata. We report our experience in 33 patients. MethodsAutologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair utilizes a 4 × 14 cm piece of fascia lata harvested through a 3-4-inch upper thigh incision. The graft is reconfigured to provide apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Patients were followed by history, SEAPI scores, POP-Q scores, and Visual Analogue Pain Score. Treatment success was defined as absence of symptomatic anterior or apical POP. ResultsThirty-three patients (mean age 63, mean follow-up 12 months) underwent AAA-POP. Treatment was successful in 31 patients (94%), and 2 failures were due to uterine prolapse. Mean harvest site Visual Analog Pain score was 0.27. Five and 7 patients developed nonbothersome thigh bulges and wound paresthesias, respectively. All 4 harvest-site seromas resolved, with 2 requiring simple aspiration. Eleven patients developed urinary retention, 10 (91%) of them after concurrent pubovaginal sling. All resolved after sling loosening (6 patients) or sling lysis (4 patients). ConclusionAAA-POP is an efficacious treatment for patients desiring nonmesh POP repair. Postoperative harvest site issues are minor and typically resolve with expectant management. Patients should be counseled about the potential risk of failure with a uterine-sparing approach and the risk of urinary retention with concurrent pubovaginal sling.