Abstract: Postoperative Urinary Retention: Incidence and Predisposing Factors

Teuvo Tammela, Matti Kontturi, and Olavi Lukkarinen. "Postoperative Urinary Retention: Incidence and Predisposing Factors." Scandinavian Journal of Urology and Nephrology 20 (September 1985): 197-201.

Objectives:
* To determine the incidence of and predisposing factors for postoperative urinary retention (the inability to void with a full bladder following surgery). Postoperative urinary retention can lead to catheterization, urinary tract infection, prolonged hospitalization, and consecutive operations.

Methods:
* Patients aged 16 or older at Oulu University Central Hospital, Finland who suffered from postoperative urinary retention were included in the study. 198 out of 5,220 patients undergoing surgery between June 1984 and June 1985 developed postoperative urinary retention.
* Patients were catheterized only after extensive efforts to make them void spontaneously had failed. Following catheterization, patients were asked for a complete medical history, especially concerning voiding, and a general physical and urological examination was conducted.

Results:
* The incidence of postoperative urinary retention was 3.8%, or 4.7% in males and 2.9% in females. Older groups generally had a higher incidence of postoperative retention, with the exception of females aged 21-40 years, who had a surprisingly high incidence of retention.
* "Most urinary retentions occurred after thoracotomies, laparotomies, and operations on the extremities, the largest group being endoprosthetic surgery of the hips and knees."
* The majority of cases of postoperative urinary retention occurred after general anesthesia.
* The voiding histories of 158 patients (79.8%) were classified as abnormal. Criteria for this classification included a history of at least one of the following symptoms: nocturnal voiding frequency (twice or more), hesitancy, poor urinary stream, intermittent voiding, or poor bladder evacuation.

Conclusions:
* "Subclinical obstructive bladder dysfunction, overdistension of the bladder during the operation, sympathomimetic and anticholinergic medication during or after anaesthesia, and an inability to stand or sit after surgery were common causes of retention." Hyperplasia of the prostate, psychic inhibition, and pain after anal dilation were also causes of retention.
* Abnormal voiding history, which often signals the presence of an occult neuropathic or obstructive bladder disorder, is an important predisposing factor for postoperative urinary retention.
* The incidence of postoperative urinary retention did not seem to be affected by premedication, type of anaesthesia, nature of the liquid given and postoperative analgetics.
* "Postoperative urinary retention is an underestimated and mostly avoidable complication. Every patient should be asked for a urinary history before an elective operation."

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