Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada,
Surg Endosc. 2013 Dec;27(12):4711-20. doi: 10.1007/s00464-013-3119-9. Epub 2013 Aug 17.
Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR.
As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher's exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05.
During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33%; p = 0.80), proportion receiving general anesthesia (70 vs. 73%; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89%; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2%).
After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.
术后尿潴留（POUR）是门诊腹股沟疝修补术的常见并发症，发生率达 38%，许多外科医生要求患者在出院前排尿。本研究旨在评估在不增加 POUR 发生率的情况下，基于膀胱扫描的排尿方案是否可以减少门诊腹股沟疝修补术后出院时间。
作为围手术期护理途径的一部分，实施了一项方案以标准化择期腹股沟疝修补术后的决策（2012 年 2 月）。患者接受膀胱扫描评估，尿液少于 600ml 的患者出院回家，尿液多于 600ml 的患者在出院前进行进出式导尿。患者收到有关排尿症状的书面信息，并指示如果在家中无法排尿，应到急诊就诊。对 2011 年 10 月至 2012 年 7 月期间计划的门诊腹股沟疝修复进行了审核。使用 t 检验、Fisher 确切检验和 Wilcoxon 秩和检验进行比较，在适当情况下使用。预先定义的统计显著性为 p 值低于 0.05。
在研究期间，124 名患者接受了疝修补术：方案实施前 60 例，实施后 64 例。研究结果显示，患者特征、腹腔镜方法（35%与 33%；p=0.80）、接受全身麻醉的比例（70%与 73%；p=0.67）或给予的静脉输液量（793ml 与 663ml；p=0.07）无显著差异。方案实施后，出院前排尿的患者比例更高（73%与 89%；p=0.02）。方案对出院时间中位数没有影响（190min 与 205min；p=0.60）。两组各有 1 例患者因 POUR 就诊于急诊（2%）。
在门诊腹股沟疝修补术后，实施基于膀胱扫描的排尿方案并未导致更早出院。POUR 的发生率低于文献报道。
