title: Postoperative urinary retention in patients undergoing elective spinal surgery.
abstract: OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: David
authors: D
authors: Altschul
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Andrew
authors: A
authors: Kobets
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Jonathan
authors: J
authors: Nakhla
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Ajit
authors: A
authors: Jada
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Rani
authors: R
authors: Nasser
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Merritt D
authors: MD
authors: Kinon
authors: Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
authors: Reza
authors: R
authors: Yassari
authors: Marcus Neuroscience Institute, Boca Raton, Florida.
authors: John
authors: J
authors: Houten
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013131:Spine / Q000601:surgery*; D062606:Tertiary Care Centers; D016055:Urinary Retention / Q000453:epidemiology* / Q000209:etiology
keywords: BPH = benign prostatic hypertrophy; IVF = intravenous fluid; PCA = patient-controlled analgesia; POUR; POUR = postoperative urinary retention; UTI = urinary tract infection; cauda equina; epidural hematoma; laminectomy; postoperative complications; risk factors; spinal surgery; urinary retention