Incidence, Outcomes, and Prediction of Postoperative Urinary Retention After a Nonurologic Procedure

Abstract

Purpose: To develop a prognostic model to estimate postoperative urinary retention (POUR) after lower limb arthroplasty. Methods: One thousand two hundred twenty patients underwent 1,374 joint replacement operations (812 knees and 562 hips) between December 2008 and May 2014. Detailed variables were collected. A multivariable logistic regression model was used to identify the independent predictors for POUR. Boot strapping and stepwise elimination was used to design a predictive nomogram. Results: There were 124 incidents of POUR (9.02%) in 118 patients (90 knee, 34 hip, P = 0.001). On univariate analysis, patients who developed POUR were older ( P < 0.001), had higher American Association of Anesthesiology scores (P = 0.007), underwent knee replacement (0.001), were obese (body mass index > 35) ( P = 0.04), and were hypertensive ( P = 0.029), with a history of benign prostatic hyperplasis (BPH) ( P < 0.001) or neurologic disorders ( P = 0.024). On multivariable analysis, age (60 to 69 years, P = 0.023, 70 to 79 yrs P = 0.008, >80 years P = 0.003), knee replacement ( P = 0.014), and history of BPH ( P = 0.013) were the independent predictors of POUR. A score was assigned to each predictor (total = 31). The C-index was 0.65. There were three risk categories as follows: 0 to 50, 51 to 85, and 86+ points resulting in 3.3%, 7.2%, and 14.0% risk of retention, respectively. Discussion: This nomogram reliably predicts the risk of POUR in patients undergoing hip and knee arthroplasties and may help planning preoperative interventions to decrease the risk of this complication.

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

“…Some studies used bladder scan to assess the volume of urine in the bladder, and POUR was diagnosed if urine volume exceeds 400 ml ( Scotting et al, 2019 ; Bracey et al, 2021 ). Some studies relied on the subjective patient reports and the clinical symptoms, such as suprapubic discomfort, distention symptoms and urinary incontinence, to define POUR ( Santini et al, 2019 ; Abdul-Muhsin et al, 2020 ). It is obvious that bladder scan has higher accuracy and sensitivity than subjective patient reports, and investigations performing bladder scan would expectedly have higher incidences of developing POUR.…”

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

“…POUR is a common issue that occurs in different operation populations with a relatively high prevalence ( 43 , 44 ). The mechanism of POUR is not yet fully elucidated, while the sympathetic stimulation secondary to pain and surgery is thought to be one of the main contributors ( 45 ).…”

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

“…Abdul-Muhsin et al 17 devised a predictive nomogram as an alternative objective assessment in a retrospective inpatient database review of 1,374 TJAs. The nomogram comprised three risk categories: 0 to 50, 51 to 85, and greater than 85 points that resulted Although neither scoring assessment has gained widespread adoption, a well-validated prediction tool to accurately risk-stratify patients would be tremendously valuable to identify patients at risk of developing POUR.…”

“…Abdul-Muhsin et al 17 devised a predictive nomogram as an alternative objective assessment in a retrospective inpatient database review of 1,374 TJAs. The nomogram comprised three risk categories: 0 to 50, 51 to 85, and greater than 85 points that resulted in a 3.3%, 7.2%, and 14.0% risk of developing POUR, respectively.…”