Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair

Roadman, Daniel; Helm, Melissa C.; Goldblatt, Matthew I.; Kastenmeier, Andrew; Kindel, Tammy L.; Gould, Jon C.; Higgins, Rana M.

doi:10.1016/j.jss.2018.05.052

Cited by 19 publications

(26 citation statements)

References 20 publications

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“…who found the incidence of POUR for patients undergoing laparoscopic (e.g., total extraperitoneal) repairs of inguinal hernias ranged from 2% to 30%. [35] POUR can result in; greater length of stay, reduced satisfaction, and higher health-care costs. Here, the authors reviewed data from 2009 to 2016 involving 578 patients who underwent laparoscopic inguinal hernia repairs; 64 (11.1%) exhibited POUR.…”

Section: Introductionmentioning

confidence: 99%

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Epstein¹

2018

Surg Neurol Int

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Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Epstein¹

2018

Surg Neurol Int

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“…Postoperative urinary retention after laparoscopic inguinal hernia repair has an incidence of 2% to 30% in the literature 20. Urinary retention prolongs hospital stay, increases healthcare costs, and reduces patient comfort 20.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative urinary retention after laparoscopic inguinal hernia repair has an incidence of 2% to 30% in the literature. 20 Urinary retention prolongs hospital stay, increases healthcare costs, and reduces patient comfort. 20 In our study, although surgeons limited the volume of fluid given for all TEP cases, postoperative urinary retention was observed at a rate of 1% in the Zig group and 4% in the non-Zig group.…”

Section: Discussionmentioning

confidence: 99%

“…20 Urinary retention prolongs hospital stay, increases healthcare costs, and reduces patient comfort. 20 In our study, although surgeons limited the volume of fluid given for all TEP cases, postoperative urinary retention was observed at a rate of 1% in the Zig group and 4% in the non-Zig group. This may be due to the longer operation time in the non-Zig group.…”

Section: Discussionmentioning

confidence: 99%

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Zig Maneuver in Total Extraperitoneal Inguinal Hernia Repair

Kurtulus

Culcu

Degerli

2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The difficulties in the hernia sac dissection in repairing large inguinal hernias with the endoscopic total extraperitoneal (TEP) technique prolong the operation and increase the risk of injury. This study investigates the effectiveness of the Zig maneuver (ligation of the hernia sac at the deep inguinal ring) in TEP in male patients with L3 inguinal hernia by European Hernia Society classification. Materials and Methods: A total of 224 male patients with L3 inguinal hernia who underwent laparoscopic TEP surgery in 2018 and 2019 were retrospectively screened and included in the study. The patients were divided into 2 groups as Zig group (n=99) and the non-Zig group (n=125), depending on whether the Zig maneuver was performed during TEP application. Results: The mean patient age was 45.49 for the non-Zig group and 47.12 for the Zig group. The median operative time was 50 minutes in the non-Zig group and 43 minutes in the Zig group (P<0.005). The median value of the postoperative first 24 hours pain score was 3 in the non-Zig group and 2 in the Zig group (P=0.033). Scrotal edema was 7.2% in the non-Zig group and 1% in the Zig group (P=0.023). According to logistic regression analysis, the Zig maneuver reduced the probability of scrotal edema by 87% in almost the entire population (odds ratio=0.130, 95% confidence interval: 0.016-1.047). There was no statistically significant difference between the groups in terms of early and late recurrence. Conclusions: Zig maneuver shortened the operative time and significantly reduced the feeling of pain in the first 24 hours postoperatively in male patients with indirect L3 hernia who underwent endoscopic TEP. It also significantly reduced the likelihood of scrotal edema in almost the entire population. As a result, the Zig maneuver is an effective method that could be applied during endoscopic TEP.

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“…Data were collected on multiple risk factors for POUR that have been identi ed in alternative operative settings, including age, benign prostatic hyperplasia (BPH), surgery duration, narcotic medication, intraoperative anticholinergic use, volume of IV uids administered, and post-operative pain score (PACU VAS) (10,11,12,13,14,15) . Data were also collected on demographics and comorbidities (e.g., body mass index, diabetes, vascular disease), α-blocker and/or 5α-reductase use, history of radical prostatectomy, and relevant intra-operative and post-operative variables.…”

Section: Variables and Outcomesmentioning

confidence: 99%

Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation

Drevik

Dalimov²,

Lucas³

et al. 2022

Int J Impot Res

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Introduction: Many implanters have transitioned penile implantation procedures from 23-hour observation (OBS) stays to same-day discharge surgeries (SDS). Postoperative urinary retention (POUR) represents a potential barrier to successful SDS among in atable penile prosthesis (IPP) recipients; however, its incidence and resolution have not been well characterized. We rigorously characterized POUR in a cohort of IPP recipients along with risk factors and management.Materials and Methods: Patients undergoing IPP from 2014 through 2020 without pre-existing retention were included. All patients underwent void trial immediately following IPP in PACU. POUR was strictly de ned as: 1) any patient requiring catheter replacement after IPP, 2) a rising post-void residual (PVR), or 3) inability to void after 6 hours regardless of whether a catheter was placed. Independent demographic, intraoperative, and postoperative risk factors for POUR were assessed using multivariable logistic regression.Results: 317 men were included of whom 27.1% experienced POUR. Rates of POUR in patients under OBS or SDS were not signi cantly different (29.2% vs. 18.0%, p=0.11). Men experiencing POUR and those not in retention were essentially indistinguishable with respect to risk factors for POUR. Only maximal medical therapy for BPH was signi cantly associated with a greater risk of POUR, a nding maintained on adjusted analysis (aOR 10.1, 95% CI 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of CIC in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of IPP infection in patients who experienced POUR vs. N-POUR did not differ (4.7% vs. 2.2% p=0.26).Conclusion: POUR is experienced in as many as 1 in 4 men undergoing IPP placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic BPH are at signi cantly greater risk of urinary retention.

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Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair

Cited by 19 publications

References 20 publications

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Zig Maneuver in Total Extraperitoneal Inguinal Hernia Repair

Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation

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