Considering healthcare value and associated risk factors with postoperative urinary retention after elective laminectomy

Cremins, Michael S; Vellanky, Smitha; McCann, Grace P; Mancini, Michael R.; Sanzari, Laura; Yannopoulos, Aris

doi:10.1016/j.spinee.2020.01.012

“…1,2 The incidence of POUR in the literature varies widely due to many factors, including type of surgery, operative duration, patient age and sex, and presence or absence of preoperative comorbidities such as obesity, diabetes, and BPH. 2,[7][8][9][10][11][12]23 Although generally benign and self-limited, POUR can cause significant patient discomfort and distress and may be compounded further by the need for urinary catheterization. Catheterization also increases the risk of developing CAUTI, particularly if an indwelling urinary catheter is needed for more than 2 days.…”

Section: Discussionmentioning

confidence: 99%

“…Although less is known about the effect of prophylactic alpha blockade on POUR in patients undergoing elective spine surgery, several risk factors for POUR in this population have been identified. These include older age, 5,6,8,9,11,23 male sex, 5,7,12,23 history of BPH or urinary retention, 5,7,9,10,23 diabetes, 5,7 increased duration of surgery, 5,8,10,11,23 and intraoperative use of phenylephrine. 19 The mechanism of POUR after spine surgery has not been completely elucidated and is clearly multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial

Rughani

¹

,

Cushing

²

,

Lary

³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The authors’ objective was to determine whether preoperative administration of tamsulosin decreases postoperative urinary retention after spine surgery. METHODS In this randomized, double-blind, placebo-controlled clinical trial performed at a single institution between 2016 and 2019, eligible males aged 50 to 85 years were administered tamsulosin or placebo for 5 days prior to elective spine surgery. Patients were excluded if they were taking alpha adrenergic blocking drugs; were allergic to tamsulosin, lactose, or sulfa drugs; had a preexisting indwelling urinary catheter, orthostatic hypotension, history of urological surgery, or renal failure; or were scheduled for cataract surgery within 2 weeks. Screening identified 1051 eligible patients (140 declined participation, 150 did not meet the inclusion criteria, and 151 did not enroll for other reasons). A total of 610 patients were randomly assigned to receive 0.4 mg oral tamsulosin or an identical placebo capsule for 5 days preoperatively and 2 days postoperatively. RESULTS A total of 497 patients were included in the final statistical analysis. The overall rate of postoperative urinary retention was 9.7%, and tamsulosin had no observed effect on reducing the rate of postoperative urinary retention as compared with placebo (9.4% vs 9.9%, p = 0.96). There were no significant differences in the reported adverse events between groups. Multivariate logistic regression was performed to model the effects of patient, surgical, and anesthetic factors on postoperative urinary retention, and the study drug remained an insignificant factor. CONCLUSIONS This study did not detect an effect of perioperative tamsulosin on reducing the rate of postoperative urinary retention in male patients aged 50 to 85 years who underwent elective spine surgery. This study does not support the routine use of tamsulosin to reduce postoperative urinary retention in patients without a previous prescription. It is unknown if subpopulations exist for which prophylactic tamsulosin may reduce postoperative urinary retention.

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“…Pre-operative risk factors for post-operative urinary retention are reportedly advanced age, male sex, history of urinary retention, and prostatic hypertrophy. Intraoperative and post-operative factors include dural tear, exposure of the cauda equina, post-operative hematoma, and prolonged surgery [ 1 , 3 , 4 , 5 ]. In our study, the age at surgery was over 65 years in all patients.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Severe Post-operative Urinary Retention after Spinal Surgery for Lumbar Spinal Stenosis: A Technical Review and Five-patient Case Series

Takaoka¹,

Orita²,

Inage³

et al. 2022

JOCR

0

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Introduction: Post-operative urinary retention is a common complication of posterior spine surgery for lumbar spinal stenosis. However, it can result in considerable difficulty for the patient, especially when it is severe, as in cases of complete retention. Therefore, it is crucial to consider its risk factors. This report provides a retrospective review of cases with severe post-operative urinary retention with the aim of elucidating its possible risk factors. Case Presentation: Data of five patients with post-operative urinary retention after posterior spine surgery for lumbar spinal stenosis, operated in our facility from 2013 to 2020, were analyzed. Their age, preoperative Japanese Orthopaedic Association ( JOA) score, presence of pre-operative bladder and bowel disorders (BBD), presence of pre-operative muscle weakness, the mean number of vertebral levels operated on, complications such as intraoperative dural tear and hematoma, operative time, estimated blood loss, JOA score in the early post-operative period, and the recovery period for the urinary retention symptoms were examined. The mean pre-operative JOA score was 8.4, and the mean number of operated levels was 2.8. The incidence of pre-operative BBD, pre-operative muscle weakness, intraoperative dural tears, and post-operative hematoma was two each. The mean operative time was 242 min, mean estimated blood loss was 352 g, and the mean JOA score in the early post-operative period was 5.8. The recovery period for urinary retention ranged from 4 days to 9 months postoperatively; one patient also had cervical and thoracic spinal stenosis and underwent decompression of all stenotic levels for relief from complete urinary retention. Conclusion: In our retrospective review of cases with severe post-operative urinary retention after lumbar spinal stenosis surgery, all patients had severe pre-operative symptoms and spinal stenosis at multiple levels. An awareness of potential risk factors and carefully and gently performing the intraoperative procedures can facilitate lesser damage to the spinal nerve. Keywords: Urinary retention, severe preoperative symptoms, hematoma, dural tear, multiple spinal stenosis.

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“…The acupuncture was conducted once a day. Both groups were treated for 21 consecutive days, and the therapeutic outcome was observed [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions

Wang

¹

,

Wang

²

,

Zhang

³

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the effect observation on modified Zishen Tongguan decoction combined with acupuncture in the treatment of urinary retention after cervical cancer surgery and its influence on the incidence of adverse reactions. Methods. The clinical data of 84 patients suffered from urinary retention after radical resection of cervical cancer (December 2018–December 2019) in the oncology department of Jinan Municipal Hospital of Traditional Chinese Medicine were selected for retrospective analysis. According to the order of admission, they were divided into group A (n = 42), treated with conventional therapy, modified Zishen Tongguan decoction, and acupuncture, and group B (n = 42), treated with conventional therapy. The clinical efficacy of the two groups was observed, the urination function indexes after therapy were recorded, and the clinical efficacy and incidence of adverse reactions were analyzed. Results. After therapy, compared with group B, the average urinary flow rate, maximum urinary flow rate, bladder compliance (BC) level value, and the number of patients with good recovery of bladder function of group A were obviously higher P < 0.05 , and the urination time and detrusor pressure were obviously lower P < 0.001 . There was no significant difference in the average scoring of overactive bladder syndrome score (OABSS) between the two groups at 7 days of therapy p > 0.05 . The average OABSS of group A at 14 days of therapy was obviously lower than that of group B P < 0.001 . Compared with group B, the total clinical effective rate of group A was obviously higher P < 0.05 , while the total incidence of adverse reactions was obviously lower P < 0.05 . Conclusion. Modified Zishen Tongguan decoction combined with acupuncture is a reliable method to treat urinary retention after cervical cancer surgery, which greatly improves the urination function of patients, as well as the clinical efficacy. Further research will help create a better solution for patients with urinary retention after cervical cancer surgery.

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Considering healthcare value and associated risk factors with postoperative urinary retention after elective laminectomy

Cited by 15 publications

References 21 publications

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial

Prevention of Severe Post-operative Urinary Retention after Spinal Surgery for Lumbar Spinal Stenosis: A Technical Review and Five-patient Case Series

Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions

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