Postoperative urinary retention in men is common after carotid endarterectomy and is associated with advanced age and prior urinary tract infection.
OBJECTIVE
This study was undertaken to analyze the occurrence of postoperative urinary retention (POUR) after carotid endarterectomy (CEA) and determine whether there are any associated modifiable risk factors. CEA was chosen to minimize the confounding effects of known risk factors for POUR, including immobilization, regional and severe pain, and neuroaxial anesthesia.


METHODS
This was a retrospective record review of 186 male patients undergoing CEA between 2007 and 2011. Demographic, comorbidities, and operative characteristics were compared. Continuous variables are reported as median and interquartile range (IQR) and categoric variables as frequencies and proportions. Pearson χ(2) or Mann-Whitney U tests compared categoric and continuous variables, respectively. Logistic regression was used to examine univariate and multivariate odds of POUR. Multivariate analysis controlled for known predictors of urinary retention. Association with other complications was examined with the Pearson correlation coefficient.


RESULTS
POUR occurred in 34 patients (18.3%). Median age and history of urinary tract infection (UTI) were significantly associated with POUR: median age was 73.0 years (IQR, 67-80 years) for those with POUR vs 69.5 years (IQR, 63-76 years) for those without (P = .047); 17.6% of patients with a history of UTI developed POUR vs 5.9% without (P = .023). These findings persisted on multivariate analysis controlling for known predictors of POUR (body mass index, history of diabetes, benign prostate hyperplasia, and prior prostate surgery): median age (odds ratio, 1.05; 95% confidence interval, 1-1.1) and history of UTI (odds ratio, 4.16; 95% confidence interval, 1.23-14.05; P = .022). The occurrence of POUR was significantly correlated with postoperative UTI: 18.8% with POUR vs 0.7% without (Pearson r = 0.369; P < .001).


CONCLUSIONS
POUR requiring bladder catheterization after CEA predisposes patients to postoperative UTI and is more common in older patients and those with a history of UTI. CEA patients lack inherent risk factors for POUR and would be a useful population for prospective studies involving POUR.
Department of Vascular Surgery, Henry Ford Health System, Detroit, Mich; Vattikuti Urology Institute, Henry Ford Health System, Detroit, Mich. Electronic address: lcampbe5@hfhs.org.
Logan
L
Campbell
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Mich.
Jesse
J
Sammon
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Mich.
Haider
H
Rahbar
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Mich.
Suketu
S
Patel
Department of Pediatric Urology, Detroit Medical Center, Detroit, Mich.
Cortney
C
Wolfe-Christensen
Department of Vascular Surgery, Henry Ford Health System, Detroit, Mich.
Loay
L
Kabbani
Department of Vascular Surgery, Henry Ford Health System, Detroit, Mich.
Alex
A
Shepard
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014552:Urinary Tract Infections / Q000150:complications*