Urecholine® prophylaxis for urinary retention in anorectal surgery

Bowers, Fredrick J.; Hartmann, Rene; Khanduja, K. S.; Hardy, Thomas G.; Aguilar, Pedro Serrano; Stewart, William R.

doi:10.1007/bf02556921

Cited by 19 publications

(10 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of these factors are not modifiable, including age, male sex, and type of surgery. [23][24][25][26][27] Other factors are modifiable and lead to changes in practices associated with anorectal surgery. In general, epidural and spinal anesthesia have been associated with higher rates of urinary retention [25][26][27] compared with monitored anesthesia care.…”

Section: Infectionmentioning

confidence: 99%

Complications Following Anorectal Surgery

Kunitake

Poylin

2016

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

Anorectal pathology is prevalent throughout the world, with most anorectal complaints being transient and without the need for formal medical evaluation. For those that do require surgical intervention for their anorectal pathology, the surgery can usually be done safely in the outpatient setting with minimal morbidity. However, no intervention is without risk, and complications frequently arise after anorectal surgery, with rates upward of 50% in some studies. 1 The purpose of this chapter is to review the short-and long-term complications that can arise after anorectal surgery, including the diagnostic approach, interventions, and prevention strategies for these complications. Short-Term/Acute Complications Postoperative HemorrhageMinor bleeding after anorectal surgery is common. Since we expect patients to continue with normal bowel function, the already disturbed anorectal mucosal becomes further irritated with activity and bowel movements. Since some bloody discharge is normal, the patient should be appropriately counseled on what to expect so as to avoid unnecessary anxiety and phone calls. It may also be helpful to remove/wash out clots from the rectum while still in the operating room to minimize confusion after surgery. However, major bleeding can also occur, albeit rarely, and may require further intervention. While the presentation of major bleeding is not uniform, patients often report frequent passing of small to moderate amounts of clot and bright red blood starting after the first bowel movement.Hemorrhoid surgery involves the vascular cushions of the anus, so not surprisingly, hemorrhoidectomy is associated with higher rates of bleeding when compared with other anorectal procedures. 1-3 Bleeding after other anorectal procedures such as procedures for anal fistula or fissure is very low (0.4-1.2%). 4,5 Rates of clinically significant bleeding after hemorrhoid surgery vary based on type of the procedure. For conventional hemorrhoidectomy (Milligan-Morgan and Ferguson) and bipolar energy device hemorrhoidectomy (Ligasure), rates of clinically significant hemorrhage has been reported in the range of 0.3 to 6%, with an average of around 2%. 1-3,6,7 There does not seem to be a significant difference in rates of bleeding between conventional hemorrhoidectomy and bipolar energy device assisted procedures.The timing of bleeding after hemorrhoidectomy varies, and can be generally divided into immediate and delayed. 5 Immediate bleeding occurs within 24 to 48 hours of a procedure and is likely related to loss of control of the vascular pedicle. Delayed bleeding is defined as bleeding reported up to 2 weeks postprocedure, and is more often related to infection or local trauma. 4,5 Delayed bleeding may be influenced by post-operative pain medications. Hemorrhoidectomy is associated with significant postoperative pain, and multimodality management is routinely employed to help alleviate discomfort. NSAIDS are an integral part of this pain management and can increase the incidence of bleeding. 8 Keywords ► anor...

show abstract

Section: Infectionmentioning

confidence: 99%

Complications Following Anorectal Surgery

Kunitake

Poylin

2016

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

show abstract

“…After removal of duplicate records, 6415 reports were identified of which 48 studies (5644 participants) were included in the review ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

“…Eleven , , , , were judged at high risk of bias; these studies evaluated pharmacological (7 studies) and non‐pharmacological (3) interventions for the prevention of PO‐UR, and a pharmacological intervention (1 study) for the treatment of PO‐UR. There were 27 studies , , , , , , , rated as having some concerns; these studies evaluated pharmacological (16 studies) and non‐pharmacological (5) interventions for the prevention of PO‐UR, and pharmacological (2) and non‐pharmacological (4) interventions for treating PO‐UR.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of interventions for the prevention and treatment of postoperative urinary retention

et al. 2018

View full text Add to dashboard Cite

BackgroundPostoperative urinary retention (PO‐UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO‐UR that might be alternatives to urinary catheterization.MethodsElectronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO‐UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random‐effects meta‐analysis. The overall quality of the body of evidence was rated using the GRADE approach.ResultsSome 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO‐UR. Based on GRADE, there was high‐certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha‐blockers (number needed to treat to prevent one case of PO‐UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay.ConclusionPromising interventions exist for PO‐UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.

show abstract

“…The fluid volume is reported to be a significant factor causing urinary retention. 2,4,9 Petros and Bradley 2 reported that the administration of at least 1,000 ml of intravenous fluid perioperatively produced a significant increase in the postoperative urinary retention (up to 45 percent). Bowers et al 9 and Jee and Son 4 reported that 3 percent urinary retention developed with < 200 ml of administered intravenous fluid.…”

Section: Discussionmentioning

confidence: 98%