Predictive factors for recovery from acute urinary retention after non-urogenital surgery

Abstract

Purpose: We performed this study to investigate the predictive factors that are related to recovery from acute urinary retention after non-urogenital surgery. Materials and Methods: We retrospectively analyzed the records of 160 patients who were referred to the department of urology because of lasting acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2006. Patients were divided into two groups: a transient retention group, which included patients who recovered voiding capability after urinary catheterization for 7 days, and the unresponsive retention group, which included patients who did not recover voiding capability. Surgical factors, patient factors, use of patientcontrolled analgesia (PCA), amount of residual urine, and medications during catheterization were analyzed. Results: In the chi-square analysis, gender (female, p=0.006), age (≥60 years old, p<0.001), preoperative voiding difficulty (p=0.028), comorbidity with hypertension (p=0.001), diabetes mellitus (p=0.003), location of surgery (pelvic cavity, p=0.005), amount of intraoperative fluid (≥4,000 ml, p=0.002), and intraoperative indwelling of Foley catheter (p=0.026) were found to differ significantly between the two groups. In the multivariate logistic regression analysis, gender (female, p=0.002; OR=5.6), age (≥60 years old, p=0.001; OR=5.9), hypertension (p=0.049; OR=2.6), location of surgery (pelvic cavity, p<0.001; OR=20.125), and amount of intraoperative fluid (≥4,000 ml, p=0.001; OR=8.5) were found to increase the risk of unresponsive urinary retention. The residual urine volume of the unresponsive urinary retention group was larger than that of the transient urinary retention group (741±306 ml vs. 614±222 ml, p=0.003). Conclusions: Use of a preoperative indwelling catheter and careful management of urination is necessary to prevent unresponsive urinary retention in patients with risk factors such as female gender, old age, hypertension, surgery in the pelvic cavity, and a large amount of intraoperative fluid injection.