Risk and Management of Postoperative Urinary Retention Following Spinal Surgery
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Postoperative urinary retention (POUR) is a common complication after spinal surgery. However, no clear definition of POUR currently exists, and no studies have evaluated the management of POUR. We aimed to investigate the prognostic factors for eventual POUR-free status in spinal surgery patients. Methods: The records of patients who received a urologic consultation for POUR from January 2015 to December 2016 were reviewed. POUR-free status was defined as a voiding volume (VV) >100 mL and a VV ratio >50%. Patients with an indwelling Foley catheter and those with any postoperative complications were excluded. The patients were divided into 2 groups according to the primary management method (Foley catheterization [FC] or intermittent catheterization [IC]). Results: In total, 205 patients (median age, 70.6 years) were evaluated. Significant prognostic factors for eventual POUR-free status were intraoperative FC, previous spinal surgery, operative level (L3–5), lumbar fusion, and total volume (TV) at the time of POUR. Bladder training and medication did not reduce the time to POUR-free status. In patients who underwent FC, the duration of indwelling FC was a significant prognostic factor for POUR-free status. In a subanalysis, the TV (≥500 mL) and VV ratio at the time of POUR were significant prognostic factors for POUR-free status after primary management. Among the patients who achieved a POUR-free status, 8 (6.4%) experienced recurrent POUR. The VV ratio (<62.0%) was the only predictor of recurrent POUR. Conclusions: The criterion of POUR-free status is useful after spinal surgery. IC and FC were similar in their efficacy for the management of these patients.
Abstract
Purpose: Postoperative urinary retention (POUR) is a common complication after spinal surgery. However, no clear definition of POUR currently exists, and no studies have evaluated the management of POUR. We aimed to investigate the prognostic factors for eventual POUR-free status in spinal surgery patients. Methods: The records of patients who received a urologic consultation for POUR from January 2015 to December 2016 were reviewed. POUR-free status was defined as a voiding volume (VV) >100 mL and a VV ratio >50%. Patients with an indwelling Foley catheter and those with any postoperative complications were excluded. The patients were divided into 2 groups according to the primary management method (Foley catheterization [FC] or intermittent catheterization [IC]). Results: In total, 205 patients (median age, 70.6 years) were evaluated. Significant prognostic factors for eventual POUR-free status were intraoperative FC, previous spinal surgery, operative level (L3–5), lumbar fusion, and total volume (TV) at the time of POUR. Bladder training and medication did not reduce the time to POUR-free status. In patients who underwent FC, the duration of indwelling FC was a significant prognostic factor for POUR-free status. In a subanalysis, the TV (≥500 mL) and VV ratio at the time of POUR were significant prognostic factors for POUR-free status after primary management. Among the patients who achieved a POUR-free status, 8 (6.4%) experienced recurrent POUR. The VV ratio (<62.0%) was the only predictor of recurrent POUR. Conclusions: The criterion of POUR-free status is useful after spinal surgery. IC and FC were similar in their efficacy for the management of these patients.
참고문헌 (26)
- Toozs-Hobson P, "Voiding difficulties in the elderly", Post Reprod Health, 20, pp.143~147 (2014)
- Brooks ME, "Urologic complications after surgery on lumbosacral spine", Urology, 26, pp.202~204 (1985)
- Schwab JH, "The surgical management of sacral chordomas", Spine(Phila Pa 1976), 34, pp.2700~2704 (2009)
- Baldini G, "Postoperative urinary retention : anesthetic and perioperative considerations", Anesthesiology, 110, pp.1139~1157 (2009)
- Carr LK, "Voiding dysfunction following incontinence surgery : diagnosis and treatment with retropubic or vaginal urethrolysis", J Urol, 157, pp.821~823 (1997)
- Michelson JD, "Urinary-bladder management after total joint-replacement surgery", N Engl J Med, 319, pp.321~326 (1988)
- Wyndaele JJ, "Neurologic urinary incontinence", Neurourol Urodyn, 29, pp.159~164 (2010)
- Lo KL, "Long-term outcome of patients with a successful trial without catheter, after treatment with an alpha-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia", Int Urol Nephrol, 42, pp.7~12 (2010)
- Akkoc A, "Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia", Int Braz J Urol, 42, pp.578~584 (2016)
- Madani AH, "Effectiveness of tamsulosin in prevention of post-operative urinary retention : a randomized double-blind placebo-controlled study", Int Braz J Urol, 40, pp.30~36 (2014)
- Lee S, "Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis", Spine J, 17, pp.469~477 (2017)
- Altschul D, "Postoperative urinary retention in patients undergoing elective spinal surgery", J Neurosurg Spine, 26, pp.229~234 (2017)
- Mevcha A, "Etiology and management of urinary retention in women", Indian J Urol, 26, pp.230~235 (2010)
- Wright JD, "The influence of surgical volume on morbidity and mortality of radical hysterectomy for cervical cancer", Am J Obstet Gynecol, 205, pp.225.e1~225.e7 (2011)
- Landoni F, "Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer : a prospective randomized study", Gynecol Oncol, 80, pp.3~12 (2001)
- McLain RF, "Comparison of spinal and general anesthesia in lumbar laminectomy surgery : a case-controlled analysis of 400 patients", J Neurosurg Spine, 2, pp.17~22 (2005)
- Hansen BS, "Risk factors of post-operative urinary retention in hospitalised patients", Acta Anaesthesiol Scand, 55, pp.545~548 (2011)
- 정철, "Risk factors for urinary retention after vaginal hysterectomy for pelvic organ prolapse", Obstetrics & Gynecology Science, 59(2), pp.137~143 (2016), 대한산부인과학회[DOI]
- Toyonaga T, "Postoperative urinary retention after surgery for benign anorectal disease : potential risk factors and strategy for prevention", Int J Colorectal Dis, 21, pp.676~682 (2006)
- Geller EJ, "Prevention and management of postoperative urinary retention after urogynecologic surgery", Int J Womens Health, 6, pp.829~838 (2014)
- Alonzo-Sosa JE, "Method for transurethral catheterization for 1-3 days for pelvic floor relaxation in the postoperative period", Ginecol Obstet Mex, 65, pp.455~457 (1997)
- Siracusa G, "Neurogenic bladder and disc disease : a brief review", Curr Med Res Opin, 29, pp.1025~1031 (2013)
- Li-Hsiang Wang, "Is Bladder Training by Clamping Before Removal Necessary for Short-Term Indwelling Urinary Catheter Inpatient? A Systematic Review and Meta-analysis", Asian Nursing Research, 10(3), pp.173~181 (2016), 한국간호과학회
- Zhengyong Y, "Randomized controlled trial on the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention associated with benign prostatic hyperplasia", Scand J Urol, 48, pp.400~404 (2014)
- Geller EJ, "Diagnostic accuracy of retrograde and spontaneous voiding trials for postoperative voiding dysfunction : a randomized controlled trial", Obstet Gynecol, 118, pp.637~642 (2011)
- Madersbacher H, "What are the causes and consequences of bladder overdistension? ICI-RS 2011", Neurourol Urodyn, 31, pp.317~321 (2012)