Incidence and risk factors for urinary retention after endoscopic hernia repair

doi:10.1016/j.amjsurg.2005.10.042

The American Journal of Surgery

Volume 191, Issue 3, March 2006, Pages 381-385

Presented at the 48th Annual Meeting of the Midwest Surgical Association, Ontario, Canada, August 14–17, 2005

https://doi.org/10.1016/j.amjsurg.2005.10.042 Get rights and content

Abstract

Background

Postoperative urinary retention (PO-UR) frequently complicates the repair of inguinal hernias. The purpose of this study was to determine the incidence of and risk factors for developing PO-UR in patients undergoing endoscopic inguinal hernia repair.

Methods

The incidence of PO-UR was determined by a retrospective review of a prospective patient database for all patients undergoing inguinal hernia repair by 1 surgeon from 2001 to 2003 at a tertiary referral center. A case-control study was used to identify risk factors for the development of PO-UR.

Results

Thirty-four (22.2%) out of 153 patients undergoing endoscopic inguinal hernia repair developed PO-UR. The use of narcotic analgesia and the volume of intravenous postoperative fluid administered were significant risk factors (P < .05) for the development of PO-UR.

Conclusions

Postoperative urinary retention is common after totally extraperitoneal and transabdominal preperitoneal inguinal hernia repairs and is associated directly with increased narcotic and postoperative intravenous fluid administration.

Section snippets

Patient population

The incidence of urinary retention was determined by a retrospective chart review conducted on 153 consecutive male patients undergoing endoscopic (TEP and TAPP) inguinal hernia repair by 1 attending surgeon (D.R.F.) with the assistance of residents at the Mayo Clinic (Rochester, MN) from 2001 to 2003. Patients with an inability to void after surgery and requiring urinary catheterization were identified as having PO-UR. Clinical risk factors for the development of PO-UR were determined using a

Incidence of urinary retention

This study consisted of 153 patients undergoing 227 total hernia repairs using the TEP (n = 145) or TAPP (n = 8) approaches (Table 1). The median age for the population was 55.5 years (range, 16–81 y). Thirty-four patients developed PO-UR as defined in the Materials and Methods section, which yielded an incidence rate of 22.2%. All patients were treated for urinary retention with catheterization and observation. Two patients were treated with oral tamsulosin (.4 or .5 mg/d) in addition to

Comments

The development of PO-UR frequently complicates general surgical procedures, in particular inguinal hernioplasty, leading to both increased morbidity and costs associated with the procedure. We report a 22.2% incidence rate of PO-UR in our population of 153 men undergoing endoscopic inguinal hernia repair. Our observed incidence of PO-UR is within the range of previously reported incidence rates (0%–34.3%) after inguinal hernioplasty [5], [6]. However, our incidence rate is higher than rates

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Inguinal hernia repair is a commonly performed surgical procedure performed in adult males. Urinary retention following surgery is a known complication likely due to the adrenergic over-stimulation of smooth muscles in the bladder neck and prostate. This effect could potentially be mitigated by the use of alpha-blocker medications. A meta-analysis of randomized control trials (RCTs) was performed to analyse the evidence behind the use of alpha-blockers in the prevention of post-operative urinary retention (POUR).
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Five randomized studies describing 456 patients were identified. General or spinal anaesthetic were used. Prophylactic alpha-blockade decreases the risk of urinary retention requiring catheterisation following elective unilateral inguinal hernia repair compared to control groups (OR:0.179, 95% CI:0.043–0.747, p:0.018). Rates of urinary retention between treatment and control groups are reduced by 20.6%. No serious complications relating to alpha blockade occurred.
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Scientific paperIncidence and risk factors for urinary retention after endoscopic hernia repair

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patient population

Incidence of urinary retention

Comments

Reg Anesth Pain Med

Br J Anaesth

Am J Surg

J Surg Res

Postoperative retention of urine in general surgical patients

Eur J Surg

A study of bladder catheterization with inguinal hernia operations

Arch Surg

Alpha-adrenergic blocker for posthernioplasty urinary retention. Prevention and treatment

Arch Surg

Scientific paper
Incidence and risk factors for urinary retention after endoscopic hernia repair