The Incidence and Risk Factors for Postoperative Urinary Retention (POUR) in

the Neurosurgical Patients

Azam Basheer MD

Donald Seyfried MD, Senior StaffDepartment of Neurosurgery

Henry Ford Hosital

Detroit, MI

Introduction

• Definition: inability to empty bladder completely 1

• Sequelae 2-7:– Can lead to significant pain, anxiety and longer hospital

stays Bladder distention– Renal failure• Standard treatment:– Straight catheterization: could lead to urethral strictures,

trauma, infection and possibly delirium. 7 – Indwelling catheter re insertion if no improvement

Incidence

• POUR is reported to occur in 5 to 75% of all surgical procedures.1,7,9

• Highest in urologic, colorectal and certain orthopedics procedures

• Multifactorial in nature

POUR in Neurosurgery

• Has not been extensively studied. • Boulis et al. reported a 39.1% incidence in

503 spine patients 10

• Mclain et al reported 23% incidence in 200 lumbar spine patients 11

• Jellish et al, reported 22.9% incidence in 61 lumbar spine patients 12

Study Design

• A cohort of 137 neurosurgical patients were prospectively followed for the development of POUR between 5/2010 – 6/2011

• Definition: Post void residual (PVR) >250 ml 6 hours after the removal of the indwelling urinary catheter (IUC)

• For patients with PVR >250 ml on the third check, IUCs were re-inserted, and kept for 5-7 days.

Results

• The overall incidence of clinical POUR was 39.4%

• Statistical significance (p< 0.05) for high PVR1 was noted in – Males– Patients older than 60 years of age– Spine surgery

PVR1 information by patient characteristics:

0100200300400500

Male Female

Gender (p<0.001)

Me

an

PV

R1

(S

E)

0100200300400500

<60 years 60+ years

Age (p=0.043)

Me

an

PV

R1

(S

E)

0100200300400500

<=200 min >200 min

Surgery Time (p=0.08)

Me

an

PV

R1

(S

E)

0100200300400500

Cranial C/T Lumbar

Surgery location (p=0.012)

Me

an

PV

R1

(S

E)

PVR1 information by patient characteristics:

0100200300400500

Yes No

Diabetes (p=0.10)

Me

an

PV

R1

(S

E)

0100200300400500

Yes No

Beta Blockers (p=0.079)

Me

an

PV

R1

(S

E)

0100200300400500

Yes No

anticholinergic (p=0.634)

Me

an

PV

R1

(S

E)

0100200300400500

<=30 >30

BM I (p=0.265)

Me

an

PV

R1

(S

E)

POUR and Length of Hospital Stay (r=0.176,p=0.04).

Results cont.

• Of all patients, 24 (18%) had IUCs re-inserted postoperatively

• The association of IUC re-insertion with male gender was significant (28%, P=0.001).

• Table 3: Sensitivity, specificity and positive and negative predictive values for IUC re-insertion(actual or intended) by cutpoints of PVR1

PPV

Conclusion

• POUR is prevalent among neurosurgical patients, especially in males, older than 60 years of age, and those with spinal pathologies.

• It leads to high rates of infection, complication, cost, and longer hospital stay.

• Studies are under way to find potential points of intervention that would lead to decreased POUR incidence.

Questions?

Thank you for listeningCredit to:

Dr M. Alsaidi

Dr M. Abdulhak

Dr M. Chedid

Joanne Guiano RN

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