Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis |
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Authors: | Sungjoon Lee Chi Heon Kim Chun Kee Chung Sung Bae Park Seung Heon Yang Soo Hyun Kim Soohee Kang Ju Hee Lee Yunhee Choi |
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Institution: | 1. Department of Neurosurgery, Inje University Haeundae Paik Hospital, 875 haeun-daero, Haeundae-gu, Busan, 612-896, South Korea;2. Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea;3. Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea;4. Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea;5. Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea;6. Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea;7. Neuroscience Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE;8. Department of Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea;9. Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea |
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Abstract: | Background ContextPostoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients.PurposeThe aim of the present study was to determine the incidence of and risk factors for POUR.Study Design/SettingThis is a retrospective nested case-control study.Patient SampleA total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed.Outcome MeasuresA multivariable logistic model was utilized to identify risk factors.MethodsA systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4–6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100?mL for more than 2 days after surgery.ResultsThe incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029–1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001–1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684).ConclusionPOUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries. |
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Keywords: | Lumbar vertebra Old age Risk factor Spinal stenosis Surgery Urinary retention |
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