Systematic review of interventions for the prevention and treatment of postoperative urinary retention

J Jackson, P Davies, N Leggett, M D Nugawela, L J Scott, V Leach, A Richards, A Blacker, P Abrams, J Sharma, J Donovan, P Whiting, J Jackson, P Davies, N Leggett, M D Nugawela, L J Scott, V Leach, A Richards, A Blacker, P Abrams, J Sharma, J Donovan, P Whiting

Abstract

Background: Postoperative urinary retention (PO-UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO-UR that might be alternatives to urinary catheterization.

Methods: Electronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO-UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random-effects meta-analysis. The overall quality of the body of evidence was rated using the GRADE approach.

Results: Some 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO-UR. Based on GRADE, there was high-certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha-blockers (number needed to treat to prevent one case of PO-UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay.

Conclusion: Promising interventions exist for PO-UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the review
Figure 2
Figure 2
Forest plot comparing anaesthetic modifications for the prevention of postoperative urinary retention. A random‐effects model was used for meta‐analysis where appropriate. Odds ratios are shown with 95 per cent confidence intervals. NSAID, non‐steroidal anti‐inflammatory drug; PO‐UR, postoperative urinary retention.
Figure 3
Figure 3
Forest plot comparing alpha‐blocker administration for the prevention of postoperative urinary retention. A random‐effects model was used for meta‐analysis where appropriate. Odds ratios are shown with 95 per cent confidence intervals. PO‐UR, postoperative urinary retention.
Figure 4
Figure 4
Forest plot comparing pharmacological interventions for prevention of postoperative urinary retention. A random‐effects model was used for meta‐analysis where appropriate. Odds ratios are shown with 95 per cent confidence intervals. PO‐UR, postoperative urinary retention.
Figure 5
Figure 5
Forest plot comparing non‐pharmacological interventions for prevention of postoperative urinary retention. A random‐effects model was used for meta‐analysis where appropriate. Odds ratios are shown with 95 per cent confidence intervals. PO‐UR, postoperative urinary retention.
Figure 6
Figure 6
Forest plot comparing pharmacological and non‐pharmacological interventions for treatment of postoperative urinary retention A random‐effects model was used for meta‐analysis where appropriate. Odds ratios are shown with 95 per cent confidence intervals. PO‐UR, postoperative urinary retention.

References

    1. Niël‐Weise BS, van den Broek PJ. Urinary catheter policies for short‐term bladder drainage in adults. Cochrane Database Syst Rev 2005; (3)CD004203.
    1. Alamanda VK, Springer BD. Perioperative and modifiable risk factors for Periprosthetic Joint Infections (PJI) and recommended guidelines. Curr Rev Musculoskelet Med 2018; 11: 325–331.
    1. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009; 110: 1139–1157.
    1. Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg 1998; 87: 816–826.
    1. Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J et al Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 2005; 101: 592–596.
    1. Zhao S, Meng Fan J, Jin Ying H, Ma Y, Li Wen W, Mi X. Non‐Drug Conservative Treatments for Acute Urinary Retention after Surgery in Adults; Cochrane Library, 2015. [accessed 29 June 2018].
    1. Kandadai P, Saini J, Patterson D, O'Dell K, Flynn M. Urinary retention after hysterectomy and postoperative analgesic use. Female Pelvic Med Reconstr Surg 2015; 21: 257–262.
    1. JPT Higgins, Green S. (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration: Copenhagen, 2011.
    1. Davies P, Leach V, Jackson J, Nugawela M, Whiting P, Leggett N et al Interventions for the Prevention and Treatment of Post‐operative Urinary Retention in Adults Undergoing Surgery: a Systematic Review; PROSPERO, 2016. [accessed 29 June 2018].
    1. Higgins J, Sterne J, Savović J. (eds). Announcement of revised tools to assess risk of bias in randomized trials and in non‐randomized studies. 24th Cochrane Colloquium, Seoul, 23–27 October 2016. [accessed 29 June 2018].
    1. Savović J. (ed.). Introducing a revised tool for assessing risk of bias in randomized trials (RoB 2.0). 24th Cochrane Colloquium, Seoul, 23–27 October 2016. [accessed 29 June 2018].
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Stat Med 2002; 21: 1539–1558.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003; 327: 557–560.
    1. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S et al; GRADE Working Group . Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches. BMC Health Serv Res 2004; 4: 38.
    1. Afazel MR, Jalali E, Sadat Z, Mahmoodi H. Comparing the effects of hot pack and lukewarm‐water‐soaked gauze on postoperative urinary retention; a randomized controlled clinical trial. Nurs Midwifery Stud 2014; 3: e24606.
    1. Akkoc A, Aydin C, Topaktas R, Kartalmis M, Altin S, Isen K et al Prophylactic effects of alpha‐blockers, tamsulosin and alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia. Int Braz J Urol 2016; 42: 578–584.
    1. Asadi S, Zand F. Evaluation of the Effect of Methyl‐Naltrexone in Reducing Urinary Retention after Orthopedic Surgeries under Spinal Anesthesia by Bupivacaine and Morphine; Cochrane Library, 2012. [accessed 29 June 2018].
    1. Bailey HR, Ferguson JA. Prevention of urinary retention by fluid restriction following anorectal operations. Dis Colon Rectum 1976; 19: 250–252.
    1. Basheer A, Alsaidi M, Schultz L, Chedid M, Abdulhak M, Seyfried D. Preventive effect of tamsulosin on postoperative urinary retention in neurosurgical patients. Surg Neurol Int 2017; 8: 75.
    1. Bazzazi N, Bahar HM, Asadi HK, Akbarzadeh S, Fouladi DF. Prophylactic tamsulosin in cataract surgery under general anesthesia for preventing urinary retention: a randomized clinical trial. Int Eye Sci 2014; 14: 1–3.
    1. Bowers FJ, Hartmann R, Khanduja KS, Hardy TG Jr, Aguilar PS, Stewart WR. Urecholine prophylaxis for urinary retention in anorectal surgery. Dis Colon Rectum 1987; 30: 41–42.
    1. Burger DH, Kappetein AP, Boutkan H, Breslau PJ. Prevention of urinary retention after general surgery: a controlled trial of carbachol/diazepam versus alfusozine. J Am Coll Surg 1997; 185: 234–236.
    1. Butwick A, Carter P, Dolin SJ. A pilot study of the effect of the Queen's Square external bladder stimulator on urinary retention after knee replacement surgery. Anaesthesia 2003; 58: 587–591.
    1. Cameron MD. Distigmine bromide (ubretid) in the prevention of postoperative retention of urine. J Obstet Gynaecol Br Commonw 1966; 73: 847–848.
    1. Carpiniello VL, Cendron M, Altman HG, Malloy TR, Booth R. Treatment of urinary complications after total joint replacement in elderly females. Urology 1988; 32: 186–188.
    1. Cataldo PA, Senagore AJ. Does alpha sympathetic blockade prevent urinary retention following anorectal surgery? Dis Colon Rectum 1991; 34: 1113–1116.
    1. Ehrenberg R, Bucher M. Urinary retention after spinal anesthesia: unilateral vs. bilateral spinal anesthesia with 0·5% bupivacaine – a prospective randomized study. Reg Anesth Pain Med 2010; 35: E90.
    1. El Dahab HA, Samir R, Menesy T, Adel G, Habib E. Adding neostigmine to morphine epidurally lessens the incidence of postoperative urine retention: a comparative study. Egypt J Anaesth 2011; 27: 89–94.
    1. Evron S, Magora F, Sadovsky E. Prevention of urinary retention with phenoxybenzamine during epidural morphine. Br Med J (Clin Res Ed) 1984; 288: 190.
    1. Evron S, Samueloff A, Sadovsky E, Berger M, Magora F. The effect of phenoxybenzamine on postoperative urinary complications during extradural morphine analgesia. Eur J Anaesthesiol 1984; 1: 45–54.
    1. Gallo S, DuRand J, Pshon N. A study of naloxone effect on urinary retention in the patient receiving morphine patient‐controlled analgesia. Orthop Nurs 2008; 27: 111–115.
    1. Gao W, He Z, Zhao B, Tang C, Xiao Y, Jiang M et al Different concentrations of bupivacaine on postoperative urinary retention in patients undergoing subarachnoid anesthesia. Int J Clin Exp Med 2017; 10: 10 840–10 845.
    1. Gao Y, Zhou X, Dong X, Jia Q, Xie S, Pang R. Electroacupuncture for bladder function recovery in patients undergoing spinal anesthesia. Evid Based Complement Alternat Med 2014; 2014: 892619.
    1. Gentili M, Bonnet F. Spinal clonidine produces less urinary retention than spinal morphine. Br J Anaesth 1996; 76: 872–873.
    1. Goldman G, Leviav A, Mazor A, Kashtan H, Aladgem D, Greenstein A et al Alpha‐adrenergic blocker for posthernioplasty urinary retention. Prevention and treatment. Arch Surg 1988; 123: 35–36.
    1. Gönüllü NN, Dülger M, Utkan NZ, Cantürk NZ, Alponat A. Prevention of postherniorrhaphy urinary retention with prazosin. Am Surg 1999; 65: 55–58.
    1. Gottesman L, Milsom JW, Mazier WP. The use of anxiolytic and parasympathomimetic agents in the treatment of postoperative urinary retention following anorectal surgery. A prospective, randomized, double‐blind study. Dis Colon Rectum 1989; 32: 867–870.
    1. Hansen AB, Olsen KS. The number of in‐out catheterisations is reduced by mobilising the postoperative patient with bladder needs to the toilet in the recovery room: a randomised clinical trial. Eur J Anaesthesiol 2015; 32: 486–492.
    1. Hershberger JM, Milad MP. A randomized clinical trial of lorazepam for the reduction of postoperative urinary retention. Obstet Gynecol 2003; 102: 311–316.
    1. Hozack WJ, Carpiniello V, Booth RE Jr. The effect of early bladder catheterization on the incidence of urinary complications after total joint replacement. Clin Orthop Relat Res 1988; 231: 79–82.
    1. Joelsson‐Alm E, Ulfvarson J, Nyman CR, Divander MB, Svensén C. Preoperative ultrasound monitoring can reduce postoperative bladder distension: a randomized study. Scand J Urol Nephrol 2012; 46: 84–90.
    1. Kau YC, Lee YH, Li JY, Chen C, Wong SY, Wong TK. Epidural anesthesia does not increase the incidences of urinary retention and hesitancy in micturition after ambulatory hemorrhoidectomy. Acta Anaesthesiol Sin 2003; 41: 61–64.
    1. Khan MTJ, Saeed S, Ali A, Qureshi MA, Alam SN. Use of diclofenac sodium post Milligan–Morgan hemorrhoidectomy reduces the risk of post‐operative urinary retention. Rawal Med J 2015; 40: 84–87.
    1. Kim JH, Jang SM, Shim MC, Jee D. The effects of pudendal block in voiding complication after anal surgery. J Korean Soc Coloproctol 2000; 16: 365–370.
    1. Kim JY, Lee SJ, Koo BN, Noh SH, Kil HK, Kim HS et al The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy. Br J Anaesth 2006; 97: 414–418.
    1. Kim SB, Lee IO, Kong MH, Lee MG, Kim NS, Choi YS. Early ambulation reduces the incidence of urinary retention after spinal anesthesia for benign anorectal surgery. Korean J Anesthesiol 1999; 37: 1001–1006.
    1. Kim SB, Lee IO, Kong MH, Lee MK, Kim NS, Choi YS. The effect of anal packing on urinary retention after hemorrhoidectomy under the spinal anesthesia. Korean J Anesthesiol 2000; 38: 30–34.
    1. Kim SH, Lee IO, Kim DH, Moon HY, Koo BH. The effects of early ambulation on urinary retention and postdural puncture headache following anal operations: a prospective randomized study. J Korean Soc Coloproctol 1999; 15: 179–185.
    1. Kim TH, Choo DH, Kim W, Ahn SW, Kim MW, Kim HT. Effects of fentanyl or clonidine on postoperative analgesia and urinary retention after caudal anesthesia. Korean J Anesthesiol 2001; 40: 625–630.
    1. Kozol RA, Mason K, McGee K. Post‐herniorrhaphy urinary retention: a randomized prospective study. J Surg Res 1992; 52: 111–112.
    1. Leach D, Spaulding J, Thomas J, Conn C, Kutash M. The effect of caffeine on postoperative urinary retention after joint replacement surgery. Orthop Nurs 2013; 32: 282–285.
    1. Lee CY, Kim HC, Lee DH. A prospective study on the relationship between postoperative urinary retention and amount of infused fluid during surgery of benign anal diseases under spinal anesthesia. J Korean Soc Coloproctol 1999; 15: 357–361.
    1. Li N, He HB, Wang CW. [Clinical observation of urinary retention after hemorrhoid and fistula operation treated with suspen‐ding moxibustion.] Zhongguo Zhen Jiu 2010; 30: 571–573.
    1. Livne PM, Kaplan B, Ovadia Y, Servadio C. Prevention of post‐hysterectomy urinary retention by alpha‐adrenergic blocker. Acta Obstet Gynecol Scand 1983; 62: 337–340.
    1. Lose G, Lindholm P. Prophylactic phenoxybenzamine in the prevention of postoperative retention of urine after vaginal repair: a prospective randomized double‐blind trial. Int J Gynaecol Obstet 1985; 23: 315–320.
    1. Madani AH, Aval HB. Comparison of Effectiveness of Tamsulosin with Placebo in Prevention of Urinary Retention after Scrotal Surgeries, Varicocelectomy and Herniorrhaphy; Cochrane Library, 2015. [accessed 29 June 2018].
    1. Madani AH, Aval HB, Mokhtari G, Nasseh H, Esmaeili S, Shakiba M et al Effectiveness of tamsulosin in prevention of post‐operative urinary retention: a randomized double‐blind placebo‐controlled study. Int Braz J Urol 2014; 40: 30–36.
    1. Mohammadi‐Fallah M, Hamedanchi S, Tayyebi‐Azar A. Preventive effect of tamsulosin on postoperative urinary retention. Korean J Urol 2012; 53: 419–423.
    1. Petersen MS, Collins DN, Selakovich WG, Finkbeiner AE. Postoperative urinary retention associated with total hip and total knee arthroplasties. Clin Orthop Relat Res 1991; 269: 102–108.
    1. Petersen TK, Husted SE, Rybro L, Schurizek BA, Wernberg M. Urinary retention during i.m. and extradural morphine analgesia. Br J Anaesth 1982; 54: 1175–1178.
    1. Placer Galán C, Mujika JA, Elósegui JL, Irureta I, Bollo E, Esteban E et al [A single rectal diclofenac dose reduces post‐haemorrhoidectomy urine retention: results of a randomised, controlled clinical study.] Cir Esp 2008; 83: 301–305.
    1. Rardin CR. Percutaneous Posterior Tibial Nerve Stimulation for the Treatment of Acute Postoperative Voiding Dysfunction; Cochrane Library, 2014. [accessed 29 June 2018].
    1. Rardin CR, Sung VW, Wohlrab KJ, Washington BB, Erekson EA. A randomized, sham‐controlled trial of posterior tibial nerve stimulation for the treatment of acute postoperative voiding dysfunction. J Pelvic Med Surg 2011; 17(Suppl 1): S8.
    1. Tammela T. Prevention of prolonged voiding problems after unexpected postoperative urinary retention: comparison of phenoxybenzamine and carbachol. J Urol 1986; 136: 1254–1257.
    1. Tomaszewski D, Bałkota M. Intramuscular administration of drotaverine hydrochloride decreases both incidence of urinary retention and time to micturition in orthopedic patients under spinal anesthesia: a single blinded randomized study. Biomed Res Int 2015; 2015: 926953.
    1. Tomaszewski D, Bałkota M, Truszczyński A, Machowicz A. Intrathecal morphine increases the incidence of urinary retention in orthopaedic patients under spinal anaesthesia. Anaesthesiol Intensive Ther 2014; 46: 29–33.
    1. Voelckel WG, Kirchmair L, Rehder P, Garoscio I, Krappinger D, Luger TJ. Unilateral anesthesia does not affect the incidence of urinary retention after low‐dose spinal anesthesia for knee surgery. Anesth Analg 2009; 109: 986–987.
    1. Zand F, Amini A, Asadi S, Farbood A. The effect of methylnaltrexone on the side effects of intrathecal morphine after orthopedic surgery under spinal anesthesia. Pain Pract 2015; 15: 348–354.
    1. Tan ZN, Zhu XL, Li BY, Wang JL, Sun YH, Li XF et al Meta‐analysis of effectiveness of moxibustion in treatment of postoperative urinary retention. World J Acupunct Moxibustion 2016; 26: 64–70.
    1. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Control Practices Advisory Committee . Guideline for prevention of catheter‐associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31: 319–326.
    1. Buckley BS, Lapitan MC. Drugs for treatment of urinary retention after surgery in adults. Cochrane Database Syst Rev 2010; (10)CD008023.
    1. Ghuman A, de Jonge SW, Dryden SD, Feeney T, Buitrago DH, Phang PT. Prophylactic use of alpha‐1 adrenergic blocking agents for prevention of postoperative urinary retention: a review and meta‐analysis of randomized clinical trials. Am J Surg 2018; 215: 973–979.
    1. Lapitan MCM, Buckley BS, Lascano R, Abalajon MJ. Drugs for the Prevention of Postoperative Urinary Retention in Adults; Cochrane Library, 2013. [accessed 29 June 2018].
    1. Schulz KF, Altman DG, Moher D; CONSORT Group . CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332.

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