Incidence and Risk Factors for the Development of Post Operative Urinary Retention in Neurosurgery

PatientsMohammed Alsaidi MD; Azam Basheer MD; Joanne Guanio RN; Lonni Schultz PhD; Muwafak Abdulhak MD; Mokbel K.

Chedid MD, FACS; Donald M. Seyfried MDHenry Ford Health System

Introduction

Post operative urinary retention(POUR) is a commonly encounteredproblem in the adult neurosurgicalpatients. Few have reported on itsexact incidence, and its etiology is notwell established. POUR can potentiallylead to urogenital damage, prolongedhospital stays, higher costs, andinfections.We attempt here to elucidate some ofthe risk factors that contribute to theincidence of POUR in differentneurosurgical patients in a singleinstitution.

Methods

A cohort of 137 neurosurgical patientswere prospectively followed between5/2010 and 3/2011 for thedevelopment of POUR. POUR wasdefined as a post void residual (PVR)> 250 ml 6 hours after the removal ofthe indwelling urinary catheter ( IUC).For any patients with PVR > 250,straight catheterization wasperformed. For those with PVR > 250ml on the third check, IUCs were re-inserted, and kept in for 5-7 days.Subsequently, patients’ records werereviewed for age, gender, BMI, lengthof surgery, type of surgery, diabetes,usage of selective alpha blockers andhospital stay.

ResultsOf the 137 patients enrolled, therewere 68 (50%) males, 41% were 60years or older, 86% underwent spinalsurgery, and 54% had anesthesia timelonger than 200 mins. The overallincidence of clinical POUR was 39.4%(54/137).Higher PVR1 was noted in males,patients older than 60 years of age,and those who underwent spinesurgery (Figure 1). When consideringall patient characteristics, the threevariables that remained significant inthe multivariable regression analysiswere gender, duration of anesthesia,and surgery type (spine vs. cranial).Of all patients, 24 (18%) had IUCs re-inserted postoperatively (Table 1).The association of IUC re-insertionwith gender was significant, withmales having higher rates of re-insertion than females (28% vs. 7%,P=0.001). Patients older than 60compared to younger patients hadhigher re-insertion rates (25% vs.12%, p=0.055). Longer duration ofanesthesia (>200 min) vs. shorter(=200 min) was associated withhigher re-insertion rates (23% vs.11%, p=0.069)

ConclusionsPOUR is a prevalent condition in theneurosurgical patients. Its overallincidence is about 40%. Male gender,time of anesthesia > 200 minutes,older age as well spinal surgery arethe most significant risk factorsassociated with POUR in theneurosurgical patients.

Table 1

Indwelling urinary catheter (IUC) re

insertion rates by patient

characteristics

Image 1

Learning Objectives

1) Male gender, time of anesthesia >200 minutes, older age as well spinalsurgery are the most significant riskfactors associated with POUR in theneurosurgical patients.2) Incidence of POUR isunderappreciated in the neurosurgicalcommunity3) Further studies are needed to helpus better understand others etiologies,risk factors, and potential prevention ofsuch problem which ultimately will leadto better patient outcomes and costeffectiveness.

References

1. Daniela M. Darrah, Tomas L. Griebling, JeffreyH. Silverstein, “Postoperative Urinary Retention”,Anesthesiology Clin (2009) 27:465–4842. Robert Mclain, Iain Kalfas, Gordon R. Bell,John Tetzlaff, Helen Yoon, Maunakrana, “Comparison of spinal and general anesthesia inlumbarlaminectomy surgery: a case-controlled analysisof 400 patients”, J. Neurosurg Spine (2005)2:17–223. Gabriele Baldini, Hema Bagry, Armen Aprikian,Franco Carl, “Postoperative UrinaryRetentionAnesthetic and PerioperativeConsiderations”, Anesthesiology(2009)110:1139–574. Boulis NM, Mian FS, Rodriguez D, et al."Urinary retention following routine neurosurgicalspine procedures." Surg Neurol 2001;55(1):23–75. Petros JG, Rimm EB, Robillard RJ, Argy O."Factors influencing postoperative urinaryretention in patients undergoing elective inguinalherniorrhaphy." Am J Surg. 1991; 161:431–433.

Table 1

Indwelling urinary catheter (IUC) re insertion rates by patient characteristics

Image 1