title: Urinary Retention After Hysterectomy and Postoperative Analgesic Use.
abstract: OBJECTIVE
  This study aimed to determine risk factors, including postoperative analgesic use, for the development of postoperative urinary retention (PUR) after hysterectomy for routine gynecologic indications using a case-control study design.
  
  
  METHODS
  Cases of PUR after hysterectomy were identified from billing data. Cases were those patients requiring recatheterization for inability to void. Controls were similarly identified and matched by age and date of surgery in a 3:1 control-to-case ratio. Chart review was performed to obtain demographic, medical, surgical, anesthetic, and medication data. Cumulative and interval doses of postoperative narcotic were recorded and converted into morphine equivalents. Crude odds ratios (ORs) were determined for potential risk factors for PUR using standard statistical analysis. Conditional logistic regression was used on multivariate models, including cumulative postoperative narcotic use, to determine adjusted ORs for risk factors.
  
  
  RESULTS
  Twenty-six cases of PUR were matched with 78 controls. The cases had a higher body mass index (32 vs 28 kg/m2, P = 0.02), had a higher preoperative use of tricyclic antidepressants (TCA; 19.2% vs 1.3%, P = 0.004), were more likely to present preoperative urinary retention associated with fibroids (19.2% vs 0%, P < 0.01), and received a higher cumulative narcotic dose in the postoperative period (109 vs 73.6 mg, P < 0.001). In a multivariate model, preoperative TCA use (OR, 30.1; 95% confidence interval, 1.99-456; P = 0.01) and cumulative narcotic dose (OR, 2.54; 95% confidence interval, 1.44-4.56; P < 0.01) were significantly associated with PUR.
  
  
  CONCLUSIONS
  Postoperative urinary retention after hysterectomy is associated with higher postoperative narcotic dose, preoperative TCA use, and preoperative urinary retention.
authors.affiliation: From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA.
authors.forename: Padma
authors.initials: P
authors.lastname: Kandadai
authors.forename: Jyot
authors.initials: J
authors.lastname: Saini
authors.forename: Danielle
authors.initials: D
authors.lastname: Patterson
authors.forename: Katharine
authors.initials: K
authors.lastname: O'Dell
authors.forename: Michael
authors.initials: M
authors.lastname: Flynn
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D016015:Logistic Models; D008875:Middle Aged; D011184:Postoperative Period; D012307:Risk Factors; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology*
chemical_list: D000700:Analgesics