The incidence and risk factors for postoperative urinary retention in neurosurgical patients
Donald SeyfriedMohammed AlsaidiJoanne GuanioAzam BasheerLonni SchultzMuwaffak AbdulhakDavid R. NerenzMokbel Chedid
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Abstract:
Postoperative urinary retention (POUR) is a common problem in adult neurosurgical patients. The incidence of POUR is unknown and the etiology has not been well established. POUR can lead to urogenital damage, prolonged hospital stay, higher cost, and infection. This study elucidates several risk factors that contribute to POUR in a variety of neurosurgical patients in one institution.A total of 137 neurosurgical patients were prospectively followed up for the development of POUR, which we defined as initial postvoid residual (PVR1) >250 ml 6 hours after removal of an indwelling urinary catheter (IUC). For patients with PVR >250 ml on the third check, IUCs were reinserted and kept in for 5-7 days.Of the 137 patients, 68 (50%) were male, 41% (56/137) were 60 years or older, 86% (118/137) underwent spinal surgery, and 54% (74/137) had anesthesia over 200 minutes. Overall incidence of clinical POUR was 39.4% (54/137). Significantly higher rates of PVR1 >250 were noted in males, patients older than 60 years, and those who underwent spine surgery. When considering all patient characteristics (except selective alpha blockers), only gender, surgery time, and surgery type remained significant. In addition, PVR1 >250 was positively associated with longer length of stay. Of all patients, 24 (18%) had IUCs reinserted postoperatively or should have had one (5 refused and 2 had a third PVR). The association of IUC reinsertion with male gender was significant.Male gender, time of anesthesia >200 minutes, older age, and spinal surgery are the most significant risk factors associated with POUR in neurosurgical patients.Keywords:
Urinary retention
Etiology
Objective To explore the clinical efficacy of 25 G spinal needle with ultra low-dose bupivacaine spinal anesthesia in anorectal surgery. Methods 348 patients treated with anorectal surgery in our hospital from January 2014 to December were selected and randomly divided into the control group and the observation group.The control group was given conventional anesthesia,which was 22 G spinal needle with regular doses bupivacaine.The observation group was given 25 G spinal needle with ultra low-dose bupivacaine.The anesthesia efficacy,recovery status after anesthesia,the incidence rate of adverse reaction and patients satisfaction degree with the effect of anesthesia in two groups was compared. Results The total effective rate of the observation group was higher than that of the control group,with significant difference(P 0.05).The time of two legs muscle recovery and self-voiding recovery time in the observation group was shorter than that in the control group,with significant difference(P0.05).The incidence rate of adverse reaction shch as hypotension,headache,tachycardia and urinary retention in the observation group after anesthesia was lower than that in the control group,with significant difference(P0.05).The satisfaction rate of anesthesia in the observation group was higher than that in the control group,with significant difference(P0.05). Conclusion 25 G spinal needle with ultra low-dose bupivacaine spinal anesthesia has significant efficacy in the anorectal diseases surgery,with advantage of fewer complications,faster recovery and higher patient satisfaction degree.
Urinary retention
Clinical efficacy
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Urinary retention
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Objective : The purpose of this study was, to determine effect of spinal low-dose isobaric bupivacaine for anorectal surgery. Methods : This descriptive study consist of 40 patients undergoing spinal anesthesia with 0.5% isobaric bupivacaine 5 mg. for anorectal surgery. We recorded data of level of anesthesia, mean arterial blood pressure, heart rate, urinary retention, nausea, vomiting and shivering. Result : At 5 minutes all patients had level of anesthesia between S4 and T12 and at 60 minutes 12 patients had completely recovery from spinal anesthesia. None of the patients had level of anesthesia above T10. The average of MAP decreased significantly at 5, 15, 15, 30, 45 and 60 minutes from baseline, but not more than 20%. One patient had urinary retention, two had vomiting at recovery room and one had shivering. Conclusion : The use of 5 mg. spinal isobaric bupivacaine can be sufficient, early recovery, low severity of hypotension and few other side effects for anorectal surgery.
Shivering
Urinary retention
Isobaric process
Mean arterial pressure
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Objective To investigate the effects of spinal anesthesia with low dose bupivacaine in the hemorrhoidectomy. Methods 150 patients,ASA physical status Ⅰ～Ⅱ,scheduled for the hemorrhoidectomy with spinal anesthesia,were randomly divided into 3 groups,50 in each group:0.5% bupivacaine 1ml for Group A,0.5% bupivacaine 1.5 ml for Group B,0.5% bupivacaine 2ml for Group C as control.All the patients were received certain concentrations of bupivacaine in subarachnoid space,respectively.The several data,such as onset time,extent and duration of sensory block,the time reached maximum extent of sensory block,degree of motor block,recovery of motor block and urination function,the incidence of urinary retention,blood dynamic changes and other side effects were recorded,respectively. Results The anesthetic effects were satisfactory in all patients.The significantly differences in onset time,and the time reached the maximum extent of sensory block were observed among 3 groups,the longest in group A,the shortest in group C,p0.05.The degree of motor block in group A were significantly less than that in group B and C,p0.05.The duration of analgesia,the recovery of motor function,and the recovery of urination function,which were effected in dose-dependent manner,were significantly different among 3 groups,and the shortest in group A,the longest in group C,p0.05.The incidence of urinary retention in group A and B were significantly lower than that in group C,p0.05. Conclusion The selective spinal anesthesia with the 5mg or 7.5mg bupivacaine for the hemorrhoidectomy,showed satisfactory anesthetic effect,and the less degree of motor block,and the lower incidence of post-operation urinary retention.The best anesthetic effect was observed in Group A.
Urination
Urinary retention
Motor block
Motor nerve
Subarachnoid space
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Objective To observe the therapeutic effects of combined spinal-epidural anaesthesia in operation of urinary system. Methods Fifty-two patients were chosen from hospital who were going to be operated because of urinary system diseases. They were randomly divided into two groups with 26 cases in each, each group had 26 patients. The patients who would be operated under combined spinal-epidural anaesthesia were set as group A. Others who would be operated under epidural block were set as B.The pespects of two groups were observed and compared, such as blood pressure after anaesthesia, the time the anaesthesia begin to effect, the time the drug arrive to the eighth thoracic vertebrae, the doses of the drug, the score of VAS. Results There were significant differences in blood pressure between two groups 5 to 10 minutes after anesthesia(P0.05). And the time the anaesthesia began to effect, the time the drug arrived to the eighth thoracic vertebrae were also different(P0.05). Compared with group B,the rate of good results of group A were higher(χ2=4.27,P=0.04). Conclusion Combined spinal-epidural anaesthesia has many advantages: quicker effects,less doses,better anesthesia effects, so it can be used as the most priority anesthesia in urinary operations.
Urinary retention
Epidural block
Combined spinal epidural
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Conventional spinal anesthesia has many complications like hypotension, bradycardia, urinary retention, post-dural puncture headache (PDPH), transient or permanent neurological symptoms. These complications can be minimized by performing unilateral spinal anesthesia in patients requiring one sided lower limb surgeries. Low anesthetic doses, pencil point or cutting point needles, slow injection rate and the lateral position help in achieving unilateral spinal anesthesia. This prospective study aimed at investigating the effects of unilateral spinal anesthesia with low dose (5 mg) hypobaric bupivacaine minimizing hemodynamic changes, limiting the cephalad dispersion of the anesthetic and promoting a faster recovery.
Supine position
Urinary retention
Intrathecal
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Aims: This study evaluated the safety, feasibility, and short-term outcomes of laparoscopic extralevator abdominoperineal excision (laparoscopic-ELAPE) with primary suturing for low rectal cancer. Materials and Methods: Consecutive patients who underwent laparoscopic-ELAPE with primary suturing for low rectal cancer at our institution between September 2013 and January 2015 were retrospectively identified from a prospectively maintained database. Short-term outcomes, including intraoperative complications, postoperative morbidity, and oncologic adequacy of surgical specimens, were evaluated. Results: Laparoscopic-ELAPE was successful in all 33 included patients, with no patient requiring conversion to an open approach. Mean operation time was 200 minutes, and mean intraoperative blood loss was 90 mL. Except for bowel perforation in 2 patients (6.1%), there were no intraoperative complications. Two patients (6.1%) had positive circumferential resection margins. Median length of hospital stay was 7 days. The 30-day morbidity and mortality rates were 15.2% and 0%, respectively. Postoperative complications within 30 postoperative days included perineal wound infection (2 patients, 6.1%), respiratory infection (2 patients, 6.1%), and chylous fistula (1 patient, 3.0%). Complications at a median follow-up time of 12 months (range, 3–19 months) included local tumor recurrence (1 patient, 3.0%), perineal dehiscence (2 patients, 6.1%), perineal seroma (1 patient, 3.0%), bowel obstruction (1 patient, 3.0%), urinary retention (2 patients, 6.1%), and chronic perineal pain (2 patients, 6.1%). There were no instances of perineal hernia, persistent sinus, or peristomal hernia. Conclusions: Laparoscopic-ELAPE with primary suturing appears to be a feasible and safe treatment approach for low rectal cancer, with acceptable short-term outcomes.
Seroma
Urinary retention
Wound dehiscence
Abdominoperineal resection
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One hundred twenty-two hernias were repaired in 101 male patients through a total extraperitoneal approach. Patients ranged from 18 to 78 years old. All repairs were done with polypropylene mesh. Five patients (5%) required conversion to an open or transabdominal approach. Patients have been followed from 6 to 20 months, with a mean of 12 months. No recurrence has developed to date. Complications included urinary retention, groin hematoma, trocar site infection, and lateral femoral cutaneous nerve neuralgia. Six patients underwent simultaneous extraperitoneal endoscopic pelvic lymph node dissections, and two patients had varicoceles repaired simultaneously. Patients returned to usual activity within 1 week.
Groin
Urinary retention
Postoperative hematoma
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