The occurrence of post-operative urinary retention in low risk patients at an academic hospital

Abstract

BACKGROUND: Post-operative urinary retention (POUR) is a post-operative complication that can lead to patient dissatisfaction. Ultrasound monitoring of bladder volume can improve patient satisfaction by early diagnosis of POUR, therefore limiting the amount of distress experienced by patients and preventing adverse effects from prolonged bladder overdistention. Unfortunately ultrasound is currently not readily available for this purpose at CHBAH. There was a perception that as much as 30% of postoperative adult patients at Chris Hani Baragwanath Academic Hospital (CHBAH) considered to be at low risk of POUR do develop urinary retention. No research has been done to assess the occurrence of POUR at CHBAH. OBJECTIVES: The primary objective of this study was to describe the occurrence of POUR in low risk patients following elective surgical procedures. The secondary objectives were to determine if the occurrence of POUR was influenced by the type of anaesthetic, the age of the patient and the gender of the patient. We also described the medications administered in our study sample in the peri-operative period. METHOD: A prospective, contextual, descriptive study design was used. Adult patients for elective surgery in orthopaedic, general surgery, ear nose and throat (ENT), maxillo-facial, plastic or ophthalmology who were considered to be at low risk for POUR and consented to participate were included. The participants received a general anaesthetic, neuraxial anaesthetic or both. In this study a convenience sampling method was used. The researcher approached patients preoperatively to inform them about the study and obtain consent, and again 12 – 24 hours following surgery to collect data. Data was captured on a data capture sheet. In consultation with a biostatistician a sample size of 150 participants was calculated using the program nQuery Advisor. Data was captured onto a Microsoft Excel spread sheet for analysis. Descriptive statistics were used to summarise the participants’ information. RESULTS: The study included 156 participants. In this study only one participant had POUR therefore the occurrence of POUR was 0.64%. The volume of urine drained on catheterisation in this participant was 2000 ml. This study could not determine whether the occurrence of POUR was influenced by the type of anaesthetic, the age or the gender of the patient. Systemic opioids were used in the peri-operative period in 99.25% of patients who received a general anaesthetic and 95.24% of patients who received neuraxial anaesthesia. Non-steroidal anti-inflammatory drugs (NSAIDs) were administered in 88.46% of all the participants in the peri-operative period. Of the participants who received a general anaesthetic atropine was used in 44.03%, β-agonists in 10.45% and α-agonists in 11.94% of patients. CONCLUSION: The occurrence of POUR in low risk patients at CHBAH is low. The volume of urine drained at catheterisation in the participant who had POUR is alarming. This study could not determine whether POUR was influenced by age, gender or type of anaesthetic. Multimodal analgesia is commonly prescribed in the peri-operative period at CHBAH.