Prophylactic Administration of Alpha Blocker for the Prevention of Urinary Retention in Males Undergoing Inguinal Hernia Repair Under Spinal Anesthesia: Interim Analysis of a Randomized Controlled Trial

Koukoulis, Georgios; Bouliaris, Konstantinos; Perivoliotis, Konstantinos; Tepetes, Konstantinos

doi:10.7759/cureus.19669

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…Spinal anesthesia does not influence the functions of the bladder sphincter muscle. Common causes of urinary retention include paralysis of the bladder sphincter and insensitivity to the micturition reflex caused by single spinal anesthesia, reflex spasms of the urethral sphincter caused by incision pain after perineum surgery, changes in micturition posture after surgery, excessive fluid replacement, and mental and psychological factors ( 25 , 26 ). Other studies have shown that factors that influence urinary retention after spinal anesthesia include the operation time and local anesthetic dosage ( 27 – 29 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients

et al. 2023

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BackgroundAnorectal diseases are common in the population and include internal, external, and mixed hemorrhoids. Although hemorrhoid surgery is a brief operation, anesthesia, anesthetic drugs, drug concentrations, and anesthesia level control are closely related to postoperative uroschesis. For hemorrhoid surgery, a single spinal block with ropivacaine is commonly used that blocks the S2-S4 parasympathetic nervous system, which in turn governs the voiding reflex, causing postoperative urinary retention; this affects the recovery of patients. This study was performed to investigate the effects of two doses ropivacaine that provided satisfactory analgesia and muscle relaxation and inhibited adverse reflexes on urinary retention after hemorrhoidectomy.MethodsThe study included 200 male patients who underwent anorectal surgery with American Society of Anesthesiologists (ASA) grade I–II single elective spinal anesthesia between March 2021 and March 2022. Patients were randomly assigned to 2 groups using a random number table: Group A (n = 100) received 10 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml), and Group B (n = 100) received 15 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml).ResultsThe anal sphincter exhibited good relaxation, and no obvious traction pain or significant difference in the time of muscle strength recovery was observed between the 10 mg and 15 mg 0.5% ropivacaine groups (P > 0.05). The 10 mg 0.5% ropivacaine group had shorter time of micturition exceeding 100 ml and lower voiding International Prostate Symptom Score than the 15 mg 0.5% ropivacaine group (P < 0.01).ConclusionsSingle spinal anesthesia with 10 mg 0.5% ropivacaine not only provides satisfactory anesthetic effect for hemorrhoidectomy but also has less influence on postoperative uroschesis and is worthy of clinical application.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR2,100,043,686) on February 27, 2021.

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Section: Discussionmentioning

confidence: 99%

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients

et al. 2023

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“…Postoperative urinary retention (POUR) is a well-recognized complication of IHR . Published literature has described a highly variable incidence (0.4%-41.6%) of POUR following IHR, without a clear correlation with surgical technique or other variables . Sequelae of POUR may include pain, autonomic dysregulation, urinary tract infection (UTI), and bladder overdistension or long-term voiding dysfunction .…”

Section: Introductionmentioning

confidence: 99%

“…A number of potential risk factors have been both proposed and refuted in the development of POUR following IHR, including choice of a minimally invasive surgical approach, performance of bilateral synchronous IHR, use of spinal anesthesia, administration of narcotic analgesia, infusion of higher volumes of intravenous fluid perioperatively, and a preexisting diagnosis of benign prostatic hyperplasia . In addition, perioperative α-blockade has been both supported and disputed as exerting a protective role against IHR-POUR . Much evidence has arisen from single-center studies, many of which were retrospective in design, and the contradictory nature of these findings means that uncertainty prevails.…”

Section: Introductionmentioning

confidence: 99%

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

et al. 2023

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ImportancePostoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.ObjectiveTo ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and ParticipantsThe Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.ExposureOpen or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and MeasuresThe primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.ResultsIn total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).ConclusionsThe findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.

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Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials

Zhou

Gan

et al. 2023

International Journal of Surgery

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Objective: The meta-analysis aimed to integrate the evidence of randomized control trials to estimate the efficacy of prophylactic tamsulosin on postoperative urinary retention (POUR). Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched through 1 March 2022 using predetermined keywords. Randomized control trials reporting the preventive efficacy of prophylactic tamsulosin against POUR were identified according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline. Pooled risk ratios (RRs) were calculated using a random-effects model or a fixed-effects model based on the results of heterogeneity assessment. A meta-regression analysis was performed to explore the potential sources of heterogeneity. Results: There were 14 studies with 1102 patients in the Tamsulosin group and 1119 patients in the Control group. The risk of POUR was significantly lower in the Tamsulosin group (156/1102 [14.2%] vs. 238/1119 [21.3%]; RR=0.65; 95% CI: 0.50–0.86; P=0.002; Heterogeneity: I 2=51%; P=0.01). Tamsulosin administration was associated with a higher risk of adverse events (65/614 [10.6%] vs. 39/626 [6.2%]; RR=1.72; 95% CI: 1.19–2.48; P=0.004; Heterogeneity: I 2=0%; P=0.70). The meta-regression identified the mean age of patients as the only potential source of heterogeneity. Subgroup analysis showed that the younger patients (age <50 years) might benefit more from tamsulosin intake (RR=0.36; 95% CI: 0.19–0.70; P=0.003; Heterogeneity: I 2=49%; P=0.14). Conclusions: The current meta-analysis suggested that prophylactic tamsulosin contributed to the prevention of POUR, and younger patients (<50 years) might benefit more from this preventive regimen. Tamsulosin was also associated with a higher risk of adverse events.

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Prophylactic Administration of Alpha Blocker for the Prevention of Urinary Retention in Males Undergoing Inguinal Hernia Repair Under Spinal Anesthesia: Interim Analysis of a Randomized Controlled Trial

Cited by 4 publications

References 18 publications

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials

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