Urinary retention is a big problem in ambulatory surgeries, but a recent study shows that it can be minimized when surgery centers, surgeons, and anesthesiologists make evidence-based changes.
When patients cannot urinate soon after surgery, it can delay their discharge from the surgery center and cause other problems, says R. Michael Meneghini, MD, director of the Indiana University Health Hip & Knee Center.
“If patients have urinary retention, it can cause significant kidney damage and result in a much higher rate of complications and hospital admissions,” says Meneghini, who also is an associate professor of orthopaedic surgery with the department of orthopaedic surgery, Indiana University School of Medicine.
Meneghini and colleagues studied the possible connections between hip and knee procedures, urinary retention, and anesthesia.1 In a review of 633 procedures, investigators found the overall incidence of postoperative urinary retention was 5.5%. Patients were more likely to retain urine if they were male, had a history of urinary retention, and if their anesthesia included glycopyrrolate, neostigmine, and fentanyl spinals.
Further, Meneghini and colleagues found that male patients who received glycopyrrolate with neostigmine had a 34% probability of developing postoperative urinary retention, compared to a 2.8% probability if patients did not receive such anesthesia and did not carry so many of the aforementioned risk factors. “These findings are powerful testimony to changing our practice. We now do all of our procedures without glycopyrrolate and neostigmine,” Meneghini reports.
Another factor that can affect urinary retention is the use of morphine or narcotic-based spinals. “Other data show morphine and narcotic-based spinals can do that, but we’ve avoided those for years,” Meneghini says. “We typically do a very low-dose fentanyl ... but the morphine-based ones are more severe. Fentanyl seems to be pretty well tolerated overall.” For patients with a history of urinary retention, Meneghini will avoid fentanyl, too.
In some cases, patients might need to be in an inpatient setting. “We don’t use indwelling urethral catheters in all surgeries. If someone has a history of postoperative urinary retention prostate enlargement, then we won’t do them in surgery centers. We may place a catheter in those patients and keep them overnight in the hospital,” Meneghini says.
The study’s findings are compelling. Based on the results, it may be possible for surgery centers to avoid using anesthesia agents that contribute to urinary retention. Still, Meneghini says it is important for administrators to discuss the topic with anesthesiologists before making any changes.
- Ziemba-Davis M, Nielson M, Kraus K, et al. Identifiable risk factors to minimize postoperative urinary retention in modern outpatient rapid recovery total joint arthroplasty. J Arthroplasty 2019;34:S343-S347.