The use of bladder volume measurement assessed by ultrasound in predicting postoperative urinary retention (original) (raw)
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Acta Anaesthesiologica Scandinavica, 2013
Background: Bladder catheterisation may be inconvenient for patients, delay mobilisation and risk complications. We hypothesised that by excluding pre-operatively patients at high risk of post-operative urinary retention, the majority of patients could avoid perioperative catheterisation during low-dose spinal anaesthesia. Methods: Patients undergoing total knee arthroplasty were assigned if fit for spinal anaesthesia and without severe symptoms of lower urinary tract obstruction, gross incontinence, mobilisation difficulties hindering micturition and > 200 ml residual urine volume. Bladder volume was monitored by ultrasound and temporary catheterisation advised if > 400 ml. Results: Fifty-two patients (men 54%, age 65 Ϯ 9 years, body mass index 31 Ϯ 5, 30% with history of urinary tract problems) were included. Intrathecal hyperbaric bupivacaine given was 7.8 Ϯ 1.08 mg and always 7.5 mg sufentanil providing sufficient anaesthesia in all cases. Crystalloid given during surgery was 8.5 Ϯ 4.0 ml/kg. Voluntary micturition was reached by 46 patients (88%, confidence interval (CI) 79-97%), but six (12%, CI 3-21%) needed temporary catheterisation once (four men/two women). Larger bladder volumes were found in those catheterised than those with voluntary micturition on the pre-operative (131 Ϯ 76 ml vs. 68 Ϯ 57 ml, P = 0.03) and first post-operative bladder scan (445 Ϯ 169 ml vs. 271 Ϯ 129 ml, P = 0.004). All but two patients (96%) could be mobilised the same day. No patient suffered bladder dysfunction. Conclusion: Low-dose spinal anaesthesia combined with simple selection criteria allowed for early mobilisation (96%) and avoidance of bladder catheterisation in the vast majority (88%) of patients undergoing total knee arthroplasty, and the rest (12%) only needed a single temporary catheterisation.
BackgroundKnowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or catheterization. We used the patients previously determined individual maximum bladder capacity as threshold for urinary catheterization.MethodsRisk factors for urinary catheterization were prospectively determined in 936 general surgical patients. Patients were at least 18 years of age and operated under general or spinal anesthesia without the need for an indwelling urinary catheter. Patients measured their maximum bladder capacity preoperatively at home, by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively, bladder volumes were assessed hourly with ultrasound. When patients reached their maximu...
The archives of bone and joint surgery, 2021
Background Urinary catheters (UC) are used by some surgeons during total joint arthroplasty (TJA). This study investigated the impact of intraoperative urinary catheters on postoperative urinary retention (POUR) following TJA cases. Methods We conducted a retrospective comparative study across 11 medical centers on 9,580 TJA patients. Visits to urgent care or the emergency department within 7 and 30 postoperative days were reviewed. Medical records over a 12-month period for all patients older than 18 years old were used to gather demographic and surgical data as well as the incidence of urinary tract infection (UTI). Chi-squared tests (RStudio) were used to determine statistical significance against P-Values (P) < 0.05. Results 13 (0.14%) patients returned within 7 days for POUR. POUR was more common in males [10 (0.3%) vs. 3 (0.1%) females, (P = 0.01)]. There was no difference in POUR when comparing total hip and knee arthroplasty procedures [0.16% vs. 0.12%, (P = 0.60)]. Of al...
European Journal of Orthopaedic Surgery & Traumatology, 2006
Urinary retention following total hip and knee arthroplasty is a common problem, frequently requiring catheterisation in the immediate post-operative period. The direct relationship between urinary tract instrumentation and deep sepsis in total hip replacements is well documented. This prospective study analysed 164 male patients who underwent primary arthroplasty between September 2004 and March 2005 inclusive. Upon admission and prior to surgery, all patients answered an eight-point urinary symptom questionnaire and were tested on their ability to micturate while supine. Thirtythree patients required urinary catheterisation, 131 did not. The mean age of the catheterised group was 71.4 years and the non-catheterised group was 63.6 years (P<0.001). There was no difference in blood loss between the two groups. With regards to the symptom questionnaire, the mean score in the catheter group was 4.1 and the non-catheter group was 1.8 (P<0.001). The ability to micturate in a supine position was of no predictive value with 23 patients in the catheter group able to do so. These results show the value of a urinary symptom questionnaire used pre-operatively in predicting those who may require post-operative urinary catheterisation. By appropriate use of this tool, patients with potential for post-operative retention may be identified before surgery. Keywords Infection AE Total hip replacement AE Urinary catheterisation Ne´cessite´de cathe´ter ve´sical post-ope´ratoire pre´coce dans les arthroplasties de premie`re intention
Risk factors of post-operative urinary retention in hospitalised patients
Acta Anaesthesiologica Scandinavica, 2011
Background: Post-operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the recovery room in hospitalised patients. Methods: An ultrasound-determined bladder volume 400 ml at arrival in the recovery room was used to define POUR. Multivariate regression analysis was used to identify patient and system factors linked to POUR in 773 consecutive hospitalised patients who had undergone orthopaedic, abdominal, gynaecological or plastic surgery without an indwelling urinary catheter.
Study design: Retrospective study Object: To find the risk factors for post-operative urinary retention (POUR) and identify the controllable factors that can reduce it. Background: Post-operative urinary retention (POUR) is one of the common postoperative complications and affects the recovery period after surgery. Authors hypothesize that early encouragement of first voiding trial after spine surgery may reduce incidence of POUR. The purpose of this study is to confirm the significance of the previously known risk factors and to evaluate the incidence of POUR according to the management of postoperative foley catheter. Patients and methods: From June 2014 to August 2014, 215 patients who diagnosed with spinal stenosis and had under 3 levels of surgery under general anesthesia were consecutively extracted and divided as POUR group and non-POUR group. The data includes gender, age, duration of hospital stay, hypertension, diabetes mellitus, preoperative prostate disease, number of operative level, surgical method, operative time, J Spine Res Surg 2020; 2 (2): 037-043 Journal of Spine Research and Surgery 38 amount of perioperative fluid, usage of patient controlled analgesia, presence of preoperative foley catheterization, foley removal time, and timing of first trial of void (TOV). Results: Incidence of POUR is 33 out of 195 (16.9%). The risk factors that showed a significant correlation with POUR were male gender, duration of hospital stay, preoperative prostate disease, operative time, amount of perioperative fluid, long operative level (3 level), and delay of TOV. Conclusion: This study confirmed the significance of POUR with the previously known risk factors and identified the importance of peri-operative fluid management and shortening of TOV after surgery.
Detecting postoperative urinary retention with an ultrasound scanner
Acta Anaesthesiologica Scandinavica, 2002
Background: Retention of urine is a common postoperative problem associated with risk of overdistention and permanent detrusor damage. Prevention of urinary retention by insertion of indwelling catheter may increase the risk of urinary infection. We have performed a reliability test of an ultrasound scanner, implemented in the postoperative monitoring equipment. Methods: Patients were monitored after different types of surgery under spinal anesthesia with an ultrasound scanner in the postanesthesia care unit (PACU). Patients: Patients who according to current guidelines required a urinary bladder catheter, were scanned before a catheter was inserted and urine volume was measured. These two urine volumes were compared and analyzed for agreement. Results: Nineteen female and 17 male patients were included. The mean difference between ultrasound estimates and catheter urine volume measurements was ª21.5 mL, and limits of agreement, calculated as a 95% confidence interval, were ª147 and π104 mL. This means that the urine volume estimated by ultra-
Reducing the rate of post-surgical urinary tract infections in orthopedic patients
BMJ open quality, 2018
Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%-80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a cu...
Postoperative urinary retention in patients undergoing elective spinal surgery
Journal of Neurosurgery: Spine
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 POU...
Asian Journal of Biomedical and Pharmaceutical Sciences, 2013
Background: Postoperative urinary retention (POUR) is a common and serious problem faced during early postoperative period. Incidence varies between 4 to 70%. Post operative urinary retention can be treated by conservative methods like providing privacy to the patient, relaxation exercises and mobilization. If these measures fail, only then the patient should be catheterized as a last resort. Aim: To compare between in/out catheterization and overnight catheterization and determine which method is better. Methods: This randomized controlled trial was carried out on 130 patients who developed postoperative urinary retention after randomly dividing them in two groups. Group A included patients with in/out catheterization, and group B consist of patients undergoing overnight catheterization. Results: Mean age of patients was 33.70±4.6 years for group A and 38.45±3.3 years for group B. In group A (in/out catheterization) out of 65 patients, 18 required re-catheterization. But from group B, re-catheterization was done in 3 patients only.