Factors Influencing Postoperative Urinary Retention Following Elective Posterior Lumbar Spine Surgery: A Prospective Study

Abstract

Study DesignProspective observational study.PurposeTo determine the incidence of postoperative urinary retention (POUR) in patients undergoing elective posterior lumbar spine surgery and identify the risk factors associated with the development of POUR.Overview of LiteraturePOUR following surgery can lead to detrusor dysfunction, urinary tract infections, prolonged hospital stay, and a higher treatment cost; however, the risk factors for POUR in spine surgery remain unclear.MethodsA prospective, consecutive analysis was conducted on patients undergoing elective posterior lumbar surgery in the form of lumbar discectomy, lumbar decompression, and single-level lumbar fusions during a 6-month period. Patients with spine trauma, preoperative neurological deficit, previous urinary disturbance/symptoms, multiple-level fusion, and preoperative catheterization were excluded from the study. Potential patient- and surgery-dependent risk factors for the development of POUR were assessed. Univariate analysis and a multiple logistical regression analysis were performed.ResultsA total of 687 patients underwent posterior lumbar spine surgery during the study period; among these, 370 patients were included in the final analysis. Sixty-one patients developed POUR, with an incidence of 16.48%. Significant risk factors for POUR were older age, higher body mass index (BMI), surgery duration, intraoperative fluid administration, lumbar fusion versus discectomy/ decompression, and higher postoperative pain scores (p<0.05 for all). Sex, diabetes, and the type of inhalational agent used during anesthesia were not significantly associated with POUR. Multiple logistical regression analysis, including age, BMI, surgery duration, intraoperative fluid administration, fusion surgery, and postoperative pain scores demonstrated a predictive value of 92% for the study population and 97% for the POUR group.ConclusionsPOUR was associated with older age, higher BMI, longer surgery duration, a larger volume of intraoperative fluid administration, and higher postoperative pain scores. The contribution of postoperative pain scores in the multiple regression analysis was a significant predictor of POUR.

Post-Operative Urinary Retention (Pour) in Lumbar Spine Surgery- A Prospective Study

“…The authors speculate that POUR may have a greater impact on the duration of stay, particularly, when procedures, such as microdiscectomy and lumbar decompressions, are performed on a day care basis or when the patients have a shorter postoperative stay. (14) Our study shows that diabetics was one of the individual risk factors for development of POUR. Numerous studies also have reported higher rates of POUR in diabetics.…”

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

“…Despite some reports supporting a correlation between the volumes of IV fluid administered during surgery and the incidence of POUR in patients undergoing major surgeries ( 122 – 125 ), this association has not been observed in patients undergoing spine surgeries ( 15 , 111 ). In a retrospective study including 397 patients who had undergone elective cervical, thoracic and lumbar surgery, Altschul et al ( 116 ) reported an increased incidence of POUR in those patients with longer operative times.…”

“…Postoperative urinary retention (POUR) is defined as an acute inability to void when the bladder is full after surgery, leading to patient's anxiety, discomfort, urinary tract infections, delayed hospital discharge and/or increased readmission rates ( 114 – 119 ). Most cases of POUR are associated with surgeries performed on the lumbar spine ( 15 , 116 , 119 – 121 ). Lumbar spine surgeries commonly involve the use of a Foley catheter which may cause urethral irritation and edema or reactive increase in tone of the bladder outlet, thereby contributing to POUR ( 120 ).…”

“…A reduced physiological reserve is one of the factors that has a significant impact on the response to intraoperative fluid therapy in this patient setting ( 9 ). Likewise, the volume and type of fluid administered during the surgery may be associated with the onset of post-operative complications ( 10 – 15 ).…”

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia

“…The medical comorbidities are not a contraindication for PTELD under LA 8 , 11 . In fact, the negativities of GA on the patient’s visceral function (POUR-post-operative urinary retention) and cognitive dysfunction are not hidden and may have some critical role in immediate post-operative period in spine surgeries 34 . One patient of our series was operated under GA and he took one week to recover his bladder function.…”