Post-operative urinary retention after lower extremity arthroplasty and the peri-operative role of selective alpha-1 adrenergic blocking agents in adult male patients: a propensity-matched retrospective cohort study

Schubert, Manuel F.; Thomas, Jared; Yashar, Jacob; Lee, John J.; Urquhart, Andrew G.; Gagnier, Joel; Pour, Aidin Eslam

doi:10.1007/s00264-019-04420-z

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…Our meta-analysis of RCTs contradicts the results of a propensity-matched retrospective study that demonstrated a significant 12.1 per cent decrease in the risk of POUR 32 . Although the study controlled various confounding factors through a propensity score and an adjusted analysis, a myriad of risk factors may be undetected due to the nature of the retrospective study, further contributing to unmeasured confounding bias 33 .…”

Section: Discussioncontrasting

confidence: 95%

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

et al. 2023

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Background Postoperative urinary retention (POUR) is a common complication following orthopaedic surgery. Previous studies attempted to establish the preventative role of α1-antagonist in POUR in the general surgical population; however, there is still no consensus regarding its use in orthopaedic surgery due to limited evidence. Methods Electronic databases of Cochrane Library, Embase, MEDLINE, and ClinicalTrials.gov were searched by two independent investigators from inception to 1 March 2022 to identify relevant randomized clinical trials. Two reviewers independently completed a critical appraisal of included trials by using the Cochrane Risk of Bias tool version 2.0 and extracted data from included articles. Risk of POUR was summarized as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Mean difference (MD) was used for meta-analysis of continuous outcomes. Results Five randomized clinical trials involving 878 patients (α1-antagonist, 434; placebo, 444) undergoing hip/knee arthroplasty and spine surgeries were included. One study was assessed as high risk of bias from the randomization process and was excluded from the final meta-analysis. There was no difference in the risk of POUR between patients taking α1-antagonist and the placebo in arthroplasty (RR, 0.64; 95 per cent c.i., 0.36 to 1.14) and in spine surgeries (RR, 1.03; 95 per cent c.i., 0.69 to 1.55). There was no difference in length of stay (MD, −0.14 days; 95 per cent c.i., −0.33 to 0.05). Use of α1-antagonist was associated with a higher risk of adverse events (RR, 1.97; 95 per cent c.i., 1.27 to 3.06), with a composite of dizziness, light-headedness, fatigue, altered mental status, and syncope being the most commonly reported symptoms. Conclusion In patients undergoing spinal surgery and joint arthroplasty, routine administration of perioperative α1-antagonist does not decrease risk of POUR but does increase perioperative dizziness, light-headedness, and syncope.

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Section: Discussioncontrasting

confidence: 95%

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

et al. 2023

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“…We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11]. However, the most read and cited borderline papers are dedicated to pain management and blood loss as well as the outcome studies in controversial subjects [12][13][14][15]. Some of the published papers were dedicated to analgesia and anaesthesia.…”

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confidence: 99%

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Scarlat

Mavrogenis

2021

International Orthopaedics (SICOT)

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Subjects treated in a general orthopaedic publication are innumerable. Some themes could not be included in a very specialized journal or in a technical publication because they treat "borderline" subjects such as the biology of healing in tissues, patient-related outcomes in a specific procedure, or pain management. Other papers that have a difficulty in finding a place are participation of vitamins or regimes in healing, education in preparation of patients for a specialized procedure such as joint replacement, and doctor's experience in introducing new procedures.We published many such controversial subjects related to orthopaedics and conjunctive tissue [1-3]. We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11]. However, the most read and cited borderline papers are dedicated to pain management and blood loss as well as the outcome studies in controversial subjects [12][13][14][15]. Some of the published papers were dedicated to analgesia and anaesthesia. For millennia, pain was a major subject for both patients and doctors and modern anaesthesia realized unbelievable progress in managing pre-operative and postoperative care as well as the realization of surgery "per se" [16,17]. No surgery without anaesthesia. The surgical team includes as pre-requisite the presence of a specialized anesthesiologist doctor or assistant. Difficult cases are managed correctly with pre-operative and post-operative protocols. Many patients are old, presenting comorbidities and chronic treatments such as anticoagulants or respiratory medication. Patients become more and more demanding and the cases become more complex and difficult. Is it reasonable to refuse

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“…The incidence of POUR in the literature is highly variable, ranging from 5.5% to 46.3% (Table 1). 1,2,4,[6][7][8][9][10][11][12] One reason for this wide variation is that there currently exists no standardized definition or criteria for POUR. In the literature, POUR is commonly assessed by performing a bladder scan 4 to 6 hours postoperatively and catheterizing patients if the volume of urine in the bladder exceeds 400 mL.…”

Section: Incidencementioning

confidence: 99%

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

Bracey

Barry

Khanuja

et al. 2022

J Am Acad Orthop Surg

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Postoperative urinary retention (POUR) is a disruptive complication after modern rapid recovery total joint arthroplasty. This review aims to synthesize the recent literature on POUR in the setting of total joint arthroplasty. The incidence of POUR ranges from 5.5% to 46.3%. The lack of a standardized definition of POUR accounts for some of this variability. Risk factors previously associated with the development of POUR include increasing age, male sex, benign prostatic hyperplasia, use of bupivacaine and intrathecal morphine in spinal anesthesia, glycopyrrolate, and volume of intraoperative intravenous fluid administered. Predictive scoring assessments, such as the International Prostate Symptom Score and a newer predictive nomogram, have not been adequately validated by high-quality studies. The treatment of POUR comprises either intermittent or indwelling urethral catheterization. Higher quality prospective studies are needed to allow for the standardization of all aspects of POUR from its diagnostic criteria to its treatment.

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Post-operative urinary retention after lower extremity arthroplasty and the peri-operative role of selective alpha-1 adrenergic blocking agents in adult male patients: a propensity-matched retrospective cohort study

Cited by 11 publications

References 20 publications

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

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