Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy

Article Abstract:

Inability to urinate and retention of urine may occur after surgery; it is a common complication following inguinal hernia repair. This complication is expensive in terms of both costs and health, as it requires catheterization, can result in infection, and can prolong the hospital stay and even require further surgery. A retrospective study was undertaken of 295 men who had undergone inguinal hernia repair to determine the incidence of urinary retention and identify possible factors associated with its development. Patients with enlargement of the prostate were excluded from the study. The factors evaluated were patient age, type of hernia and location, type of anesthesia, and amount of intravenous fluid given before surgery. The average patient age was 54 and the incidence of urinary retention was 14 percent (41 men). Factors associated with a higher rate of urinary retention were: use of general anesthesia, age over 53, and preoperative fluid administration of more than 1,200 milliliters (mL). The incidence of urinary retention in patients who had received general anesthesia was 19 percent, compared with 8 percent for those receiving spinal anesthesia. Patients older than 53 had an 18 percent retention rate compared with a 9 percent retention rate for patients 53 years and younger. Eighteen percent of the patients who received more than 1,200 mL of fluid before surgery experienced urinary retention, compared with 10 percent of patients who had received less fluid preoperatively. These findings suggest that the risk of urinary retention may be reduced in patients undergoing hernia repair if the amount of preoperative fluid is limited, and if spinal anesthesia is used, especially if the patient is older than 53 years of age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Urine, Urinary retention

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Must we specialize herniorrhaphy for better results?

Article Abstract:

An inguinal hernia is a protrusion of a loop of intestine through the inguinal canal (a passage in the lower abdominal wall through which the spermatic cord passes). Inguinal hernias are repaired by either general surgeons or surgeons who specialize in these procedures. Success of the procedure is determined by the rate of complications and the rate of recurrence of the hernia. Nationwide, the recurrence rate is reported to be 10 percent for primary hernia repair and 25 percent for repair of a recurrent hernia, but surgeons who specialize in hernia surgery report recurrence rates of 1 and 5 percent for primary and recurrent inguinal hernias, respectively. Improvement in the treatment of any disease is based upon progressive standardization of treatment. Because the anatomy and pathology of inguinal hernia do not vary greatly from patient to patient, this is an excellent procedure for standardization. In 1980, a specific hernia service was established at one university hospital. This service is directed by a senior medical school faculty member, and a sequential 80-step protocol is used in the management of each patient. The recurrence and infection rates of the hernia service were found to be significantly better than those of the general surgeons operating in the same facility. The hernia service has performed surgery on 1,754 patients. Seventy-five percent have been followed for seven years, and the recurrence rate is 2 percent, with an infection rate of 0.3 percent and one death. If the results obtained from inguinal hernia surgery are to be improved, there appears to be a need for specialization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medicine, Practice, Medical specialties, Inguinal hernia, editorial, Herniorrhaphy

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Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease

Article Abstract:

Surgery performed for benign anorectal disease (such as hemorrhoids, anal fissures, abscesses, and benign tumors) may be complicated by acute urinary retention, the incomplete emptying of the bladder. Several causative factors have been suggested, including decreased awareness of bladder fullness due to the use of long-acting anesthetics, and large amounts of fluid given during and immediately following surgery. A study of 111 patients undergoing surgery for benign anorectal disease is described. Urinary retention developed in 36 patients (32 percent). All 36 patients who developed urinary retention had received over 1,000 milliliters of intravenous (IV) fluid during and just after the operation. These 36 patients represented 45 percent of all patients receiving this amount of IV fluid. The use of long-acting anesthetic was also associated with increased incidence of urinary retention. Twenty-six of 56 patients who received long-acting anesthetic developed urinary retention, compared with 10 of 52 patients receiving short-acting anesthetic. The age and sex of the patient did not influence the risk for urinary retention. These results suggest that by restricting the amount of IV fluid given to patients, especially when they are receiving long-acting anesthetic, the risk of urinary retention may be reduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Postoperative complications, Rectum, Anus, Anesthetics

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